Negative pressure pulmonary oedema following use of ProSeal LMA

Abstract

Negative pressure pulmonary oedema (NPPO) is a life threatening condition, manifested due to upper airway obstruction in a spontaneously breathing patient. Upper airway obstruction caused by classic laryngeal mask airway (cLMA) and ProSeal laryngeal mask airway (PLMA) has been reported, and NPPO has also been reported following the use of cLMA. Search of literature did not confirm NPPO following the use of PLMA. We encountered a female patient of NPPO scheduled for incision and drainage of an abscess who had signs of airway obstruction following PLMA insertion. Multiple attempts were made to get patent airway without success. PLMA was replaced with endotracheal tube following which pink frothy secretion appeared in breathing circuit. Patient was managed successfully with ICU care.

Post-obstructive Pulmonary Oedema in Delayed Death by Hanging: A Case Report

“…Medicolegally, three forms of pressure over the neck are important: hanging, manual strangulation, and ligature strangulation [1]. Hanging (self-suspension) is a common method of suicide where pressure over the neck is produced due to the weight of the body itself [1][2][3][4]. Most of the cases are suicidal, except for a few accidental cases [1].…”

“…Most of the cases are suicidal, except for a few accidental cases [1]. It is a painless suicide method with immediate death due to reflex vagal inhibition, anoxia, or cerebral ischemia [1,2,3,5]. Though "once launched upon suicide by hanging, there is no retreat", a few patients survive and reach the hospital if promptly rescued, known as 'near-hanging' [1,3,4,5].…”

“…It is a painless suicide method with immediate death due to reflex vagal inhibition, anoxia, or cerebral ischemia [1,2,3,5]. Though "once launched upon suicide by hanging, there is no retreat", a few patients survive and reach the hospital if promptly rescued, known as 'near-hanging' [1,3,4,5]. Those who survive usually die at some later stage termed "delayed death by hanging" [1,4].…”

“…Death by hanging is caused by cerebral ischemia and anoxia due to cervical artery obstruction and/or airway obstruction leading to respiratory insufficiency or due to venous obstruction or fracture dislocation of the cervical vertebra [1,6]. Most patients develop neurological and respiratory complications immediately [3]. Delayed deaths due to hanging occur due to infarction of the brain, hypoxic encephalopathy, aspiration pneumonia, infections, Duret haemorrhage, oedema of the lungs, oedema of the larynx, or pulmonary complications like acute respiratory distress syndrome (ARDS) [4,5].…”

“…The exact mechanism of POPE development in delayed death by hanging is still not clear [5]. One theory suggests that hypoxia of the brain in hanging results in the release of vasoactive mediators like serotonin, kinins, and histamine, which results in pulmonary hypertension, pulmonary vasoconstriction, and pulmonary congestion [3,5]. Another theory postulates that there is damage to the pulmonary capillary membrane, resulting in increased capillary permeability, thereby pulmonary oedema [3,5].…”