Negative-pressure pulmonary Hemorrhaging Due to Severe Obstructive Sleep Apnea

Kuramoto, Kemmei; Matsuyama, Masashi; Nonaka, Mizu; Takeishi, Takahiro; Oshima, Hisayuki; Matsumura, Sosuke; Nakajima, Masayuki; Sakai, Chio; Shiozawa, Toshihiro; Kiwamoto, Takumi; Tsukahara, Yusuke; Takayashiki, Norio; Ogawa, Ryoko; Morishima, Yuko; Noguchi, Masayuki; Hizawa, Nobuyuki

doi:10.2169/internalmedicine.6206-20

Cited by 3 publications

(4 citation statements)

References 14 publications

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“…There have been several reports of NPPH in the perioperative period, triggered by laryngospasm after extubation 3) . In Japan, only a few other cases of choking due to food aspiration and sleep apnea have been reported 6,7) . Table 2 summarizes the case reports of NPPH in Japan according to noninvasive etiology.…”

Section: Discussionmentioning

confidence: 99%

Laryngospasm Causing Recurrent Negative Pressure Alveolar Hemorrhage Resembling Acute Exacerbation of Interstitial Lung Disease: A Case Report

Yamaki,

Ejima,

Sato

et al. 2023

Respiratory Endoscopy

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Alveolar hemorrhage may occur during an acute exacerbation of interstitial lung disease (AE-ILD) or may be caused by a negative pressure mechanism due to upper airway obstruction such as laryngospasm in the perioperative period. There have been no reports of negative pressure pulmonary hemorrhage (NPPH) due to laryngospasm without obvious invasive factors. We experienced a case of repeated NPPH due to idiopathic laryngospasm, resembling an AE-ILD. A 62-year-old woman developed multiple alveolar hemorrhages due to a sense of obstruction in the throat, followed by bloody sputum and dyspnea. She was considered to have an AE-ILD with Sjögren's syndrome and was treated with immunosuppressive therapy but had recurrent relapses. Bronchoscopy was performed under minimal anesthesia to elicit the cough reflex by vocal cord stimulation, and findings of internal rotation and complete occlusion of the vocal cords were confirmed. She was diagnosed as NPPH due to laryngospasm, and she has been treated with muscle relaxants without recurrence. NPPH due to laryngospasm can be a differential diagnosis as a cause of alveolar hemorrhage. By confirming the diagnosis through bronchoscopic examination of the larynx under minimal anesthesia, unnecessary immunosuppressive treatment for suspected AE-ILD can be avoided and appropriate preventive treatment can be provided.

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Section: Discussionmentioning

confidence: 99%

Laryngospasm Causing Recurrent Negative Pressure Alveolar Hemorrhage Resembling Acute Exacerbation of Interstitial Lung Disease: A Case Report

Yamaki,

Ejima,

Sato

et al. 2023

Respiratory Endoscopy

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“…It is commonly considered that the permeability of pulmonary capillaries increases under the condition of negative thoracic pressure ( 41 ). In general, when pulmonary vascular compliance is low, an increase in pulmonary blood volume can alter membrane permeability and even disrupt membrane integrity, which ultimately leads to leakage of body fluids and blood cells into the alveoli ( 20 , 41 ). This damaging effect has been demonstrated both experimentally and clinically ( 1 , 42 , 43 ).…”

Section: Pathogenesis and Pathophysiological Featuresmentioning

confidence: 99%

“…Reports on mortality also vary. The mortality rate of NPPE has previously been described as 11 to 40%, with a more recent literature review showing a mortality rate of only 2% (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). A recent systematic review of NPPE in adult ear, nose and throat (ENT) surgery reported a mortality rate of 5% and identified age and ICU admission as the main risks for increased mortality (3).…”

Section: Introductionmentioning

confidence: 99%

Negative pressure pulmonary edema (Review)

Liu

Wang

et al. 2023

Exp Ther Med

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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.

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“…Auch bei der obstruktiven Schlafapnoe werden in Einzelberichten Fälle von Patienten mit nächtlichem Lungenödem und Hämoptysen beschrieben [9][10][11][12][13]. Kuramoto et al berichten von einem 24-jährigen athletischen männlichen Patienten mit seit etwa 6 Monaten bestehendem blutigen Sputum (morgendlich nach dem Aufstehen), bei dem eine umfangreiche Umfelddiagnostik keine richtungsweisende Erklärung ergeben hat [9]. Nach Durchführung einer Polysomnografie konnte eine schwergradige obstruktive Schlafapnoe mit einem AHI von 93,8/h festgestellt werden.…”

Section: Introductionunclassified

„Negativdruck-Lungenödem“ und „alveoläre Hämorrhagie“ als Komplikationen einer oberen Atemwegsobstruktion

et al. 2022

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ZusammenfassungNegativdruck-Lungenödem und alveoläre Hämorrhagie sind lebensbedrohliche Komplikationen infolge einer akuten oberen Atemwegsobstruktion. Durch die Obstruktion im Larynx-/Pharynbereich kommt es zu hohen negativen Intrapleuraldrucken, die sich, durch unterschiedliche Faktoren bedingt, auf die Integrität der alveolo-kapillären Membran auswirken. In der Übersichtsarbeit werden klinische Symptome, Ätiologie, die Pathophysiologie sowie die therapeutischen Optionen beschrieben. Ziel ist es, den Kliniker mit den Krankheitsbildern und den Komplikationen vertraut zu machen.

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Negative-pressure pulmonary Hemorrhaging Due to Severe Obstructive Sleep Apnea

Cited by 3 publications

References 14 publications

Laryngospasm Causing Recurrent Negative Pressure Alveolar Hemorrhage Resembling Acute Exacerbation of Interstitial Lung Disease: A Case Report

Laryngospasm Causing Recurrent Negative Pressure Alveolar Hemorrhage Resembling Acute Exacerbation of Interstitial Lung Disease: A Case Report

Negative pressure pulmonary edema (Review)

„Negativdruck-Lungenödem“ und „alveoläre Hämorrhagie“ als Komplikationen einer oberen Atemwegsobstruktion

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