Negative pressure pulmonary edema after orotracheal extubation in emergency surgery

Abstract

The objective is to report the case of a patient undergoing emergency partial colectomy due to acute perforative abdomen who developed negative pressure pulmonary edema after orotracheal extubation. Information was obtained through chart review, patient interview, photographic record of diagnostic methods, and literature review. MLR, 37 years old, male, previously healthy, admitted to the hospital complaining of abdominal pain. He was admitted to the operating room for laparotomy due to a diagnosis of pneumoperitoneum. Anesthetic induction was uneventful. Intraoperatively, the parameters remained stable. At the end, anesthetic weaning and extubation were performed. The patient evolved with superficial respiration and use of accessory muscles, with a rapid decrease in peripheral saturation. Based on intraoperative normality parameters, employed protective ventilation and altered auscultation, acute pulmonary edema due to negative pressure was identified. Positive pressure ventilation was performed using a face mask, with increased saturation and improvement of respiratory pattern. Ventilation was necessary until the patient ceased discomfort and remained stable with oxygenation through nasal catheter. Despite being a well-described clinical entity, this is a little known complication. Early identification and appropriate treatment are essential for clinical outcome.