Negative Pressure Pulmonary Hemorrhage

Schwartz, David R.; Maroo, Anjli; Malhotra, Atul; Kesselman, Howard

doi:10.1378/chest.115.4.1194

Cited by 118 publications

(90 citation statements)

References 22 publications

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“…Large suction catheters can generate sub-atmospheric pressures and may elicit extravasation of fluid into the alveoli. 3 Pulmonary hemorrhage has also been associated with paroxysmal coughing, which also occurred in this patient. 4 The copious secretions at the end of surgery could have been attributed to a light plane of anesthesia or repeated use of suction.…”

supporting

confidence: 51%

Negative pressure pulmonary edema: endobronchial intubation or acute lung injury in a predisposed patient?

Garg

2009

Can J Anesth/J Can Anesth

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supporting

confidence: 51%

Negative pressure pulmonary edema: endobronchial intubation or acute lung injury in a predisposed patient?

Garg

2009

Can J Anesth/J Can Anesth

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“…Hemoptysis [13][14][15] is another symptom that may be present, which in the setting of NPPE signifies capillary failure and alveolar hemorrhage. [16][17][18] Our patient presented with all these above symptoms on both occasions after he was extubated.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Negative Pressure Pulmonary Edema

Pathak¹,

Rendon²,

Ciubotaru³

2010

Clinical Medicine & Research

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Negat ive pressure pulmonary edema (NPPE) following tracheal extubation is an uncommon (0.1% prevalence) and life-threatening complication for patients undergoing endotracheal intubation with general anesthesia for surgical procedures. Negative pressure pulmonary edema is also known as "postextubation pulmonary edema," "post-obstructive pulmonary edema," or "laryngospasm-induced pulmonary edema." The common pattern in these cases is the occurrence of an episode of airway obstruction upon emergence from general anesthesia, usually caused by laryngospasm. Upper airway obstruction secondary to glottis closure following extubation leads to marked increase in negative intrathoracic pressure. This causes pulmonary edema 2 which may be unilateral or bilateral. 3,4We herein describe the first reported case of recurrent negative pressure pulmonary edema in the same patient following extubation. An African-American man, aged 34 years, underwent an elective uncomplicated right wrist laceration repair while under general anesthesia. Following extubation, the patient developed hypoxemia, tachypnea, shortness of breath, pulmonary rales, frothy sputum, decreased oxygen saturation, and evidence of upper airway obstruction. Chest radiograph showed pulmonary edema. The patient was diagnosed with post-extubation pulmonary edema (aka. negative pressure pulmonary edema [NPPE]) and was treated with intravenous furosemide and oxygen therapy; he improved remarkably within a few hours. Once stabilized, the patient described a similar episode 10 years earlier following surgery for multiple gunshot wounds.Negative pressure pulmonary edema following tracheal extubation is an uncommon (0.1%) and life-threatening complication of patients undergoing endotracheal intubation and general anesthesia for surgical procedures. The common pattern in these cases is the occurrence of an episode of airway obstruction upon emergence from general anesthesia, usually caused by laryngospasm. Patients who are predisposed to airway obstruction may have an increased risk of airway complications upon extubation after general anesthesia. Prevention and early relief of upper airway obstruction should decrease incidence.Recurrent NPPE has not been previously described in the literature. Herein, we describe the first case of recurrent NPPE in the same patient following extubation.

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“…En casos más exacerbados se añaden corticoides (paciente 2º) aunque no está demostrado su efecto beneficioso. Los pacientes con EAPPPN más graves, con hemorragia pulmonar franca requieren además ventilación mecánica con presión positiva durante unos días [15][16] . En nuestra serie, los 3 pacientes se recuperaron sin ningún tipo de secuelas.…”

Section: Discussionunclassified

Edema pulmonar por presión negativa: a propósito de 3 casos

Ortiz-Gómez¹,

Plaja-Marti²,

Sos-Ortigosa³

et al. 2006

Anales Sis San Navarra

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RESUMENEl edema agudo pulmonar por presión negativa es una complicación descrita desde 1977 tras la obstrucción de la vía aérea respiratoria, tanto en niños como en adultos. Aunque su etiopatogenia es multifactorial, destaca especialmente la excesiva presión intratoráci-ca negativa causada por la inspiración forzada espontánea de un paciente con la glotis cerrada, que resulta en trasudación de líquido de los capilares pulmonares hacia el espacio alveolointersticial. El edema pulmonar resultante puede aparecer en pocos minutos tras la obstrucción de la vía aérea o de forma diferida al cabo de varias horas. Este cuadro clínico es potencialmente grave, pero habitualmente responde bien al tratamiento con oxigenoterapia, ventilación mecánica a presión positiva y diuréticos. Es importante el diagnóstico de sospecha para adecuar el tratamiento con presteza. Presentamos nuestra experiencia en 3 casos clínicos con edema agudo pulmonar por presión negativa. Palabras clave. Edema Pulmonar. Presión negativa. ABSTRACTNegative pressure pulmonary edema is a complication, described since 1977, caused by upper airway obstruction in both children and adults. Although its aetiopathogeny is multifactorial, especially outstanding is excessive negative intrathoracic pressure caused by the forced spontaneous inspiration of a patient against a closed glottis, that causes high arteriole and capillary fluid pressures that favor transudation into the alveolar space The resulting pulmonary edema can appear a few minutes after the obstruction of the airway or in a deferred way after several hours. The clinical manifestations are potentially serious, but normally respond well to treatment with supplemental oxygen, positive pressure mechanical ventilation and diuretics. Diagnostic suspicion is important for acting promptly. We report three clinical cases with acute negative pressure pulmonary edema.

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Negative Pressure Pulmonary Hemorrhage

Cited by 118 publications

References 22 publications

Negative pressure pulmonary edema: endobronchial intubation or acute lung injury in a predisposed patient?

Negative pressure pulmonary edema: endobronchial intubation or acute lung injury in a predisposed patient?

Recurrent Negative Pressure Pulmonary Edema

Edema pulmonar por presión negativa: a propósito de 3 casos

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