The Awareness of Negative Pressure Pulmonary Edema in the Medical Intensive Care Unit

Abstract

Negative pressure pulmonary edema (NPPE) is a noncardiogenic-related rapid onset of bilateral pulmonary edema secondary to various etiologies that lead to upper airway obstruction. Despite the fact that it is more commonly seen in the emergency department (ED), pediatric intensive care unit (PICU), and the postanesthesia care unit (PACU), there is a lower disease prevalence in the medical intensive care unit (MICU) as it sometimes could be overlooked upon. Prompt treatment often leads to favorable clinical outcomes. We detail a 55-year-old lady with a past medical history of nephrolithiasis, obesity, and obstructive sleep apnea presented with right flank pain due to right kidney subcapsular hematoma and left hydronephrosis due to distal ureteral calculus requiring urological intervention. She unfortunately subsequently developed NPPE requiring MICU level of care after reintubation. Successful extubation was achieved two days later as timely recognition of NPPE led to proper treatment. She was downgraded to general medicine service and discharged without complications.

Negative pressure pulmonary edema (Review)

“…The mechanism behind hydrostatic pulmonary edema suggests that NPPE is caused by marked fluid shifts triggered by changes in the intrathoracic pressure (Fig. 1) (1,4,38). The mechanism behind increased permeability pulmonary edema suggests that the destruction of alveolar epithelium and pulmonary microvascular membranes caused by severe mechanical stress results in increased pulmonary capillary permeability and protein-rich pulmonary edema (26,38).…”

“…1) (1,4,38). The mechanism behind increased permeability pulmonary edema suggests that the destruction of alveolar epithelium and pulmonary microvascular membranes caused by severe mechanical stress results in increased pulmonary capillary permeability and protein-rich pulmonary edema (26,38). Pulmonary edema fluid/plasma protein ratio measurement is routinely used to distinguish hydrostatic pulmonary edema from increased permeability pulmonary edema, since the ability of the alveolar epithelial barrier to filter out the alveolar edema fluid is usually impaired in patients with acute lung injury but not in patients with hydrostatic pulmonary edema (26).…”

Negative-pressure pulmonary Hemorrhaging Due to Severe Obstructive Sleep Apnea

“…Negative-pressure pulmonary edema (NPPE) is a form of noncardiogenic pulmonary edema that results from the generation of high negative intrathoracic pressure to overcome upper airway obstruction, such as choking and laryngospasm after extubation or in the postoperative period after anesthesia ( 1 - 5 ). However, only a few reports have shown NPPE as a result of upper airway obstruction due to obstructive sleep apnea (OSA) ( 6 - 8 ).…”