Verzögert auftretendes, postobstruktives Lungenödem

Abstract

A young athletic male adult (smoker) developed a pulmonary edema 30 min after the end of anaesthesia. Extubation was complicated by a laryngospasm. After artificial ventilation for 12 h the patient recovered completely.A negative pressure pulmonary edema (NPPE) develops after deep inspiratory efforts with an occluded airway. Such a maneuver leads to negative intrapleural pressures of -50 to -100 mmHg. This pressure gradient causes damage to the pulmonary capillaries, a transcapillary volume shift into the interstitium,and hemodynamic changes that increase the intrapulmonary blood volume. As a NPPE may occur with a delay of up to 1 h it is crucial to provide adequate monitoring for patients at risk. Symptomatic therapy usually leads to complete recovery within several hours.

Diagnosis, prevention and management of postoperative pulmonary edema

“…Due to marked negative intrathoracic pressure (–50 to –100 cmH 2 O), there is an increase in venous return to heart with subsequent elevation of ventricular end-diastolic volumes and thus the left ventricular end-diastolic pressures are elevated leading to formation of pulmonary edema. [27–29]The hypoxemia due to upper airway obstruction leads to increased pre- and postcapillary pulmonary vascular resistance in a nonuniform manner thus elevating the pulmonary vascular resistance and a hyper-adrenergic state which precipitates pulmonary edema. [30] Not only do these mechanisms lead to fluid shift from pulmonary capillaries to perimicrovascularinterstitium but also cause disruption of alveolar capillary membrane.…”

Unterdrucklungenödem

“…Hier erfolgten Beatmung mithilfe des "continuous positive airway pressure" (CPAP) und assistierte Spontanbeatmung (ASB) mit einer inspiratorischen Sauerstofffraktion (F I O 2 ) von 0,5 und einem positiven endexspiratorischen Druck ("positive end-expiratory pressure", PEEP) von 10 [11,12].…”

Unterdrucklungenödem nach Allgemeinanästhesie

“…Das Unterdrucklungenödem ist eine be kannte anästhesiologische Komplikation (Inzidenz: 0,05-0,1%) [9]. Überwiegend sind jüngere, gesunde, muskulöse Patien ten betroffen.…”

“…In diesem Moment wird die Druck differenz zwischen Interpleuralspalt und Alveolarraum (verkürzend als intra pleuraler "Druck" bezeichnet) massiv er höht, sodass es zu exzessiven Werten bis zu −140 cm H 2 O kommen kann [4,5,9,11,15].…”

“…Lässt das klinische Bild keine eindeu tige Diagnose zu und gilt es, mögliche Differenzialdiagnosen (Aspiration, Ate lektasen, Lungen/Fettembolie, Broncho spasmus, kongenitale Herzfehler, Pneu mothorax, Transfusionsreaktion, Hyper volämie [9]) auszuschließen, kann eine radiologische Diagnostik Klarheit schaf fen.…”