Negative pressure pulmonary edema (Review)

Abstract

Negative pressure pulmonary edema (NPPE) is a complication resulting from acute or chronic upper airway obstruction, often posing challenges in recognition and diagnosis for clinicians. If left untreated, NPPE can lead to hypoxemia, heart failure and even shock. Furthermore, the drug treatment of NPPE remains a subject of controversy. The primary pathophysiological mechanism of NPPE involves the need for high inspiratory pressure to counteract upper airway obstruction, subsequently causing a progressive rise in negative pressure within the pleural cavity. Consequently, this results in increased pulmonary microvascular pressure, leading to the infiltration of pulmonary capillary fluid into the alveoli. NPPE exhibits numerous risk factors and causes, with laryngospasm following anesthesia and extubation being the most prevalent. The diagnosis of NPPE often presents challenges due to confusion with conditions such as gastroesophageal reflux or cardiogenic pulmonary edema, given the similarity in initial factors triggering both diseases. Upper airway patency, positive pressure non-invasive ventilation, supplemental oxygen and re-intubation mechanical ventilation are the foundation of the treatment of NPPE. The present review aims to discuss the etiology, clinical presentation, pathophysiology and management of NPPE.

Severe hypoxemia after extubation secondary to myxedema coma: a case report

“…The primary etiology of NPPE is attributed to the generation of strong inspiratory negative pressure resulting from upper respiratory tract obstruction. 27 Following tracheal intubation and subsequent mechanical ventilation, resolution of the upper airway obstruction in our patient led to gradual resolution of the pulmonary edema ( Figure 1 ).…”

Negative pressure plmonary oedema after adenotonsillectom: a case report and litrature review

“…Usually the sign and symptoms of NPPE can be seen within 5 min but it can occur at any time after reliving of obstruction. In our case the symptom was seen with in 5 min as most cases but Koid.M and other researchers showed that there will be a probability of developing pulmonary oedema 1–6 h after upper airway obstruction 9 , 11 .…”

“…From the statistics of the Australian Incident Monitoring Study, the reported incidence rate of NPPE in patients with laryngospasm was 3% 8 . Thus, the incidence of NPPE can be ranged between 0.1 and 12% 9 . The incidence is higher in men (80%) and ASA physical states I and II (73%).…”

Unmasking Negative Pressure Pulmonary Edema Following Hanging: A Case Series

“…New treatments such as facedown positioning, inhaled nitric oxide, high-frequency breathing, surfactant therapy, and extracorporeal membrane oxygenation are currently being experimented with [ 16 ]. Research has been conducted on the use of bronchodilators in pulmonary edema, as studies suggest that bronchodilators, including β-agonists, could promote alveolar fluid clearance to lessen pulmonary edema symptoms [ 17 ].…”