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.