Diagnosis, prevention and management of postoperative pulmonary edema

Abstract

Postoperative pulmonary edema is a well-known postoperative complication caused as a result of numerous etiological factors which can be easily detected by a careful surveillance during postoperative period. However, there are no preoperative and intraoperative criteria which can successfully establish the possibilities for development of postoperative pulmonary edema. The aims were to review the possible etiologic and diagnostic challenges in timely detection of postoperative pulmonary edema and to discuss the various management strategies for prevention of this postoperative complication so as to decrease morbidity and mortality. The various search engines for preparation of this manuscript were used which included Entrez (including Pubmed and Pubmed Central), NIH.gov, Medknow.com, Medscape.com, WebMD.com, Scopus, Science Direct, MedHelp.org, yahoo.com and google.com. Manual search was carried out and various text books and journals of anesthesia and critical care medicine were also searched. From the information gathered, it was observed that postoperative cardiogenic pulmonary edema in patients with serious cardiovascular diseases is most common followed by noncardiogenic pulmonary edema which can be due to fluid overload in the postoperative period or it can be negative pressure pulmonary edema (NPPE). NPPE is an important clinical entity in immediate post-extubation period and occurs due to acute upper airway obstruction and creation of acute negative intrathoracic pressure. NPPE carries a good prognosis if promptly diagnosed and appropriately treated with or without mechanical ventilation.

Postobstructive pulmonary edema following accidental near-hanging

“…The most common cause of POPE type I remains postextubation laryngospasm. Other causes of obstruction of upper airway leading to POPE include: hanging, mononucleosis, strangulation, near drowning, sleep apnea, biting of the endotracheal tube while intubated, croup and epiglottitis (especially in children), choking, foreign body, postoperative vocal cord paralysis, administration of muscle relaxant at the beginning of an inhalational induction of anesthesia (paralysis of glossal muscles before diaphragm), and following aspiration of pneumothorax or massive pleural effusion [1,5]. The incidence of POPE in all anesthetics is 0.05% to 0.1% [6].…”

Role of Laryngeal Spasm in Negative Pressure Pulmonary Oedema

“…Computed tomography of chest shows a preferential central and nondependent distribution of ground glass attenuation. [6] TREATMENT After the diagnosis of NPPE has been made, treatment is directed toward reversing hypoxia and decreasing the fluid volume in the lungs. [7] Maintaining the airway and providing supplemental oxygen is usually all that is required for a positive outcome.…”

“…The true incidence might be underestimated because many cases may be misdiagnosed or undiagnosed. The overall incidence of NPPE is less than 0.1% in all surgeries performed under general anesthesia while the incidence of development of pulmonary edema in acute upper airway obstruction (type I NPPE) ranges from 9.6-12% and that in chronic airway obstruction (type II NPPE) is 44% [1] . In postextubation subglottic edema, studies have reported an incidence of NPPE of upto 9.6 percent.…”

Edema pulmonar por presión negativa secundario a parálisis bilateral de cuerdas vocales en postoperatorio de tiroidectomía total

“…Cuando hay estridor, el uso de corticosteroides ha mostrado reducción en el edema laríngeo y el requerimiento de reintubación (13). La evolución con desaparición de infiltrados pulmonares, con la instauración de presión positiva en la vía aérea y diurético en las primeras 48 horas como se describe en el caso, es el curso habitual de los edemas pulmonares no cardiogénicos asociados con cambios de presión; aunque algunos tardan más en recuperarse este retraso generalmente está asociado con diagnóstico y tratamiento tardíos (4).…”

“…Se ha informado una incidencia entre el 0,05% al 0,1% de todas las prácticas anestésicas y hasta del 11% de todos los pacientes que requieren una intervención activa para el manejo de obstrucciones de la vía aérea (2). Las complicaciones fatales pueden llegar a ser hasta del 40%, de ahí, que tener presente su fisiopatología, los hallazgos diagnósticos para un reconocimiento temprano y las medidas para un tratamiento adecuado es crucial para mejorar la calidad en la atención de los sujetos que lo padecen (3)(4)(5). Se presenta un caso de EPPN asociado a parálisis bilateral de cuerdas vocales en una paciente en postoperatorio de tiroidectomía total, a fin de recordar los aspectos más importantes de esta condición, así como, la importancia de la prevención de las lesiones del nervio laríngeo recurrente y la necesidad de una vigilancia postquirúrgica cuidadosa en sujetos con factores de riesgo y cirugía de vías aerodigestivas (6).…”