Negative-Pressure Pulmonary Edema After Routine Septorhinoplasty

Noninvasive positive pressure ventilation in patients with perioperative negative pressure pulmonary edema

“…Both types of NPPE are potentially life threatening [5,6], and early recognition and treatment are important for a favorable outcome. In the literature, 66.5-85% of cases of NPPE require tracheal intubation to ensure airway patency and to administer mechanical ventilation [3,15], and at most 20% of NPPE patients were treated by NPPV [13]. In our study, 53.3% of patients were treated successfully by NPPV.…”

“…The perioperative period is assumed to be the most likely time point for development of NPPE, and the estimated rate of occurrence in previous reports is approximately 0.1% [13,14], whereas the overall prevalence of NPPE was 0.056% in our study. Compared with the small number of clinical cases reported in the literature (fewer than 200 cases in the past 38 years) [15], the estimated frequency is apparently high, suggesting that NPPE might be underdiagnosed during the perioperative period. Both types of NPPE are potentially life threatening [5,6], and early recognition and treatment are important for a favorable outcome.…”

“…The eight patients treated by NPPV were able to restore their airway by either head tilt, chin lift, or jaw thrust until they could self-protect their airway after complete emergence from anesthesia; they were also capable of manual-assist ventilation by face mask. The seven patients treated by invasive ventilation had either a life-threatening laryngospasm requiring immediate tracheal intubation (patients 9, 12, 13), instability of the upper airway due to delayed emergence from anesthesia (patients 10, 11), or a tracheal suture by relief surgery of tracheal stenosis (patients 14,15). With close review of the charts, patients 10 and 11 had impaired consciousness and could not protect their own airway, yet it was difficult to maintain the airway by manual procedure, and they had a strong respiratory drive to produce negative intrathoracic pressure.…”

Postobstructive Pulmonary Edema

“…2,35 Patients in whom postobstructive pulmonary edema develops generally have an uncomplicated hospital course followed by the rapid resolution of the pulmonary edema and short hospital stays. 33,36 The patients in our study had similarly uncomplicated courses with an average ICU length of stay of < 4 days, a relatively low severity of illness as measured by the simplified acute physiology II score, and only a 10% mortality rate. The one patient who died experienced anoxic brain injury during airway obstruction, prompting the family to withdraw care.…”

“…24 This finding is consistent with our study in which acute postobstructive pulmonary edema developed in 8 of 10 patients in the postoperative period. 24 Other reported causes of postobstructive pulmonary edema include the following: strangulation 2 ; epiglottitis 25 ; foreign-body aspiration 26 ; hypothyroidism 27 ; inspissated tracheal secretions 24 ; hiccups 28 ; croup 29 ; thyroid goiter 30 ; temporomandibular joint arthroscopy 31 ; difficult intubation 32 ; hematoma 24 ; upper airway tumor 1 ; oropharyngeal surgery 33 ; Ludwig angina 34 ; obesity 24 ; acromegaly 30 ; obstructive sleep apnea 26 ; mediastinal tumor 24 ; and biting the endotracheal tube or laryngeal mask. 2,35 Patients in whom postobstructive pulmonary edema develops generally have an uncomplicated hospital course followed by the rapid resolution of the pulmonary edema and short hospital stays.…”