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Negative pressure pulmonary edema

Negative pressure pulmonary edema. NPPE. First described in JAMA by Oswalt in 1977 Non-cardiogenic pulmonary edema following UAO 1,2 No good data describing incidence 2,6. Risk factors. Young Healthy Athletic Male Head and neck surgery. Patho-physiology.

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Negative pressure pulmonary edema

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  1. Negative pressure pulmonary edema

  2. NPPE • First described in JAMA by Oswalt in 1977 • Non-cardiogenic pulmonary edema following UAO1,2 • No good data describing incidence2,6

  3. Risk factors • Young • Healthy • Athletic • Male • Head and neck surgery

  4. Patho-physiology • Airway obstruction (even brief)1,2,3,4,5,6,7 • Negative intrathoracic pressure (Mueller maneuver) • Increased pulmonary intravascular volume • Pulmonary capillary hydrostatic pressure overcomes pulmonary interstitial hydrostatic pressure • Aveolar-capillary membrane failure

  5. The EDEMA • Usually follows in the minutes after the obstruction in relieved • Ranges from • discernable only on CXR • the classic pink frothy foam • recently described frank blood (NPPH)4

  6. Treatment • Prevent re-obstruction • Ensure adequate ventilation and oxygenation • Fluid restriction +/- diuresis • Radiographs can be obtained to confirm dx

  7. References • Oswalt, CE, Gates, GA, Holmstrom, FMG (1977) Pulmonary edema as a complication of acute airway obstruction. JAMA 238,1833-1835 • Schwartz D, Maroo A, Malhotra A, Kesselman H (1999) Negative pressure pulmonary hemorrhage. Chest 115:1194-1197. • Tami, TA, Chu, F, Wildes, TO, et al (1986) Pulmonary edema and acute upper airway obstruction. Laryngoscope 96,506-509 • Herrick, IA, Mahendran, B, Penny, FJ (1990) Postobstructive pulmonary edema following anesthesia. J Clin Anesth 2,116-120 • McConkey, Anaesthesia Intensive Care. 2000 Feb;28(1):72-6 • Taha S et al. Complicated negative pressure pulmonary edema in a child with cerebral palsy. Paediatric Anaesthesia. 2002 Feb;12(2):181-6 • Stuth et al. Negative-pressure pulmonary edema in a child with hiccups during induction. Anesthesiology 2000; 93 :282-284 • Miller et al. Anesthesia. 2002.

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