Postextubation pulmonary edema: A case series and review

Mulkey, Zachary; Yarbrough, Shannon; Guerra, Diana; Roongsritong, Chanwit; Nugent, Kenneth; Phy, Michael

doi:10.1016/j.rmed.2008.07.002

Cited by 22 publications

(18 citation statements)

References 13 publications

(17 reference statements)

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“…Three of the 146 patients died, highlighting the potentially life-threatening nature of this anaesthetic complication. Finally, a case series of fourteen patients (12 male) from the same centre described a mean age of 34.5 and average Body Mass Index of 25.5 14. There was no significant past medical history of note in any of the patients, in keeping with the findings of the other two reviews 12 13…”

Section: Discussionmentioning

confidence: 59%

Post-operative negative pressure pulmonary oedema in an athletic male

Stewart

Johnston

2013

J R Army Med Corps

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Section: Discussionmentioning

confidence: 59%

Post-operative negative pressure pulmonary oedema in an athletic male

Stewart

Johnston

2013

J R Army Med Corps

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“…The result is an acute increase in afterload, which worsens transcapillary fluid efflux and increases interstitial and alveolar edema. 13 The pathophysiology of NPPE is attributed to four major mechanisms: Disturbances of pulmonary fluid homeostasis can be induced by four pathways that can lead to increased interstitial fluid -increased hydrostatic pressure in the pulmonary capillary bed (or conversely, decreased pressure in the interstitium), decreased osmotic pressure of plasma, increased permeability of the membrane, and decreased return of fluid to the circulation via lymphatics. 14,15 In clinical presentation, initial findings usually include decreased oxygen saturation, with pink frothy sputum and chest radiograph abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Negative Pressure Pulmonary Oedema after Sedation in a Patient Undergoing Pacemaker Implantation

Krishnamurthy¹,

Venkatesh²

2017

JCDR

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Negative pressure pulmonary oedema (NPPE) is a manifestation of upper airway obstruction and is seen after extubation postoperatively. The large negative intrathoracic pressure generated by forced inspiration against an obstructed airway is thought to be the principal mechanism involved. It is a dangerous and potentially fatal condition with a multifactorial pathogenesis. The Authors report a case of negative pressure pulmonary oedema occurring periprocedurally while undergoing permanent pacemaker implantation under local anaesthesia and light sedation due to upper airway obstruction caused by falling back of the tongue.

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“…Treatment of pulmonary edema includes fluid restriction, diuretics and continuous positive airway pressure. Most cases resolve spontaneously in a relatively short period of time with no long-term sequelae [67]…”

Section: Pulmonary Edemamentioning

confidence: 99%

Critical Care Issues After Major Hepatic Surgery

Thorat¹,

Lee²

2013

Hepatic Surgery

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Major hepatic resections have become the routine aspect of managing certain liver conditions such as primary liver malignancies and certain secondaries. Five-year survival is negligible in un-treated patients compared with around % in those receiving hepatic resection [ ]. Patients with liver disease who require surgery are at greater risk for surgical and anesthesia related complications than those with a healthy liver [ , , ]. The magnitude of the risk depends upon the type of liver disease and its severity, the surgical procedure, and the type of anesthesia.The first few days after major hepatic surgery are critical to successful outcome of the procedure. Metabolic and functional changes after hepatic resection are unique and cause significant challenges in management. A multidisciplinary approach is required along with effective communication among all caregivers. With attentive, anticipatory care, many potential problems can be averted and new problems can be detected early and treated appropriately. Contemporary critical care management after major hepatic surgery doesn't differ from standard intensive care which includes invasive hemodynamic monitoring, mechanical ventilation, vital parameter monitoring, strict antisepsis measures, metabolic control with due attention to the glycemic control and nutritional aspect which more or less always affected in the patients with cirrhosis.The post-operative management after hepatic surgery is greatly influenced by hemodynamic monitoring intraoperatively. Patient's intra-operative course, blood loss, requirement of blood products during surgery largely defines the outcome in post-operative period along with patient's nutritional status, liver functions and associated comorbidities. Hence close co-operation with the anesthesiologist and surgeon is necessary.Majority of postoperative management issues after liver resection are unique and require a thorough understanding of liver metabolism and the pathophysiology of liver disease. The purpose of this review is to elaborate on specific early postoperative management issues after liver resection, examine current evidence and present the management options. . Hepatic resections and general considerationsThrough the recent surgical advances, hepatic resection could be carried out under the condition of liver cirrhosis or obstructive jaundice, but there are many complications and associated mortality in these cases. Hepatic cirrhosis limits the ability of the liver to regenerate. Fortunately, it appears that most of the advanced cirrhotic livers can tolerate even major resections, and the presence of cirrhosis should not preclude potentially curative or life-prolonging surgery [ ]. Careful patient selection based on preoperative Child-Pugh score and ICG test, resections can be limited leaving behind enough liver parenchyma to avoid postoperative liver dysfunction. But such patients are more vulnerable to perioperative insults secondary to ischemia and hypoperfusion, which is reflected in perioperative morbidity and mortali...

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Postextubation pulmonary edema: A case series and review

Abstract: It would appear that all patients, especially young men, are at risk for the development of this syndrome and that the pathogenesis remains uncertain in many cases.

Cited by 22 publications

References 13 publications

Post-operative negative pressure pulmonary oedema in an athletic male

Post-operative negative pressure pulmonary oedema in an athletic male

Negative Pressure Pulmonary Oedema after Sedation in a Patient Undergoing Pacemaker Implantation

Critical Care Issues After Major Hepatic Surgery

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