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1
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Lin C, Wang D, Yan Y, Zhong R, Li C, Zhang J. Transnasal humidified rapid-insufflation ventilator exchange compared with laryngeal mask airway for endoscopic thoracic sympathectomy: a randomized controlled trial. Front Med (Lausanne) 2023; 10:1252586. [PMID: 38116036 PMCID: PMC10728469 DOI: 10.3389/fmed.2023.1252586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/01/2023] [Indexed: 12/21/2023] Open
Abstract
Background Transnasal humidified rapid-insufflation ventilator exchange (THRIVE) has the characteristics of operating easily and maintaining oxygenation and eliminating CO2, which makes it possible to be used in endoscopic thoracic sympathectomy (ETS). The application of THRIVE in ETS remains undefined. The purpose of this randomized controlled study is to assess the efficacy between THRIVE and laryngeal mask airway (LMA) for ETS. Methods In total, 34 patients from May 2022 to May 2023 in Huazhong University of Science and Technology Union Shenzhen Hospital undergoing ETS were randomly divided into a THRIVE group (n = 17) and an LMA group (n = 17). A serial arterial blood gas analysis was conducted during the perioperative period. The primary outcome was the arterial partial pressure of carbon dioxide (PaCO2) during the perioperative period. The secondary outcome was arterial partial pressure of oxygen (PaO2) during the perioperative period. Results The mean (SD) highest PaCO2 in the THRIVE group and LMA group were 99.0 (9.0) mmHg and 51.7 (5.2) mmHg, respectively (p < 0.001). The median (inter-quartile range) time to PaCO2 ≥ 60 mmHg in the THRIVE group was 26.0 min (23.2-28.8). The mean (SD) PaO2 was 268.8 (89.0) mmHg in the THRIVE group and 209.8 (55.8) mmHg in the LMA group during surgery (p = 0.027). Conclusion CO2 accumulation in the THRIVE group was higher than that of the LMA group during ETS, but THRIVE exhibited greater oxygenation capability compared to LMA. We preliminarily testified that THRIVE would be a feasible non-intubated ventilation technique during ETS under monitoring PaCO2.
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Affiliation(s)
| | | | | | | | - Chaoyang Li
- Department of Anesthesiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Jie Zhang
- Department of Anesthesiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
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Park HJ, Park SH, Woo UT, Cho SY, Jeon WJ, Shin WJ. Unilateral pulmonary hemorrhage caused by negative pressure pulmonary edema: A case report. World J Clin Cases 2021; 9:1408-1415. [PMID: 33644209 PMCID: PMC7896690 DOI: 10.12998/wjcc.v9.i6.1408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/28/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Unilateral pulmonary hemorrhage is typically reported in young and healthy men with upper respiratory tract obstruction during anesthesia in special situations. Negative pressure in the lungs is created, resulting in negative pressure pulmonary edema (NPPE).
CASE SUMMARY A 78-year-old male patient diagnosed with spinal stenosis was admitted to receive a unilateral laminectomy with bilateral decompression. The patient had been diagnosed with hypertension four years earlier and asthma more than 70 years earlier. We experienced a unilateral alveolar hemorrhage associated with NPPE that occurred in a longstanding asthma patient who bit the intubated endotracheal tube for a short period during posture change at the end of surgery. Because diffuse alveolar hemorrhage accompanied by NPPE was caused in this case by airway obstruction in an older patient with asthma without known risk factors, anesthesiologists should be careful not to induce airway irritation during anesthesia awakening in asthma patients.
CONCLUSION Because diffuse alveolar hemorrhage accompanied by NPPE can occur, anesthesiologists should take care not to induce airway irritation.
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Affiliation(s)
- Hyung Joon Park
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
| | - Seung Ho Park
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
| | - Un Tak Woo
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
| | - Sang Yun Cho
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
| | - Woo Jae Jeon
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
| | - Woo Jong Shin
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
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Choi WK, Lee JM, Kim JB, Im KS, Park BH, Yoo SB, Park CY. Diffuse alveolar hemorrhage following sugammadex and remifentanil administration: A case report. Medicine (Baltimore) 2019; 98:e14626. [PMID: 30813195 PMCID: PMC6408145 DOI: 10.1097/md.0000000000014626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RATIONALE Diffuse alveolar hemorrhage (DAH) is a rare life-threatening condition that accompanies general anesthesia. Negative-pressure pulmonary edema (NPPE) is a rare cause of DAH. PATIENT CONCERNS A 25-year-old male patient developed hemoptysis following remifentanil administration by bolus injection with sugammadex at the emergence from general anesthesia. DIAGNOSIS Chest x-ray and computed tomography showed DAH. INTERVENTIONS Conservative care was provided with 4L of oxygen via nasal prong, 20 mg of Lasix and 2500 mg of tranexamic acid. OUTCOMES The patient was discharged uneventfully. LESSONS Muscle rigidity by remifentanil and the dissociated reversal of neuromuscular blockade by sugammadex was suspected as the cause of NPPE-related DAH. Therefore, the possibility NPPE-related DAH should be considered when using a bolus of remifentanil and sugammadex during emergence from general anesthesia.
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Affiliation(s)
| | | | | | | | - Bong Hee Park
- Department of Urology, Uijeongbu St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Su Bin Yoo
- Department of Anesthesiology and Pain Medicine
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Han IS, Han BM, Jung SY, Yoon JR, Chung EY. Negative Pressure Pulmonary Hemorrhage after Laryngospasm during the Postoperative Period. Acute Crit Care 2018; 33:191-195. [PMID: 31723885 PMCID: PMC6786702 DOI: 10.4266/acc.2016.00689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/26/2016] [Accepted: 09/30/2016] [Indexed: 01/12/2023] Open
Abstract
Negative pressure pulmonary hemorrhage (NPPH) is an uncommon complication of upper airway obstruction. Severe negative intrathoracic pressure after upper airway obstruction can increase pulmonary capillary mural pressure, which results in mechanical stress on the pulmonary capillaries, causing NPPH. We report a case of acute NPPH caused by laryngospasm in a 25-year-old man during the postoperative period. Causative factors of NPPH include negative pulmonary pressure, allergic rhinitis, smoking, inhaled anesthetics, and positive airway pressure due to coughing. The patient’s symptoms resolved rapidly, within 24 hours, with supportive care.
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Affiliation(s)
- In Soo Han
- Department of Anestheiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bo Mi Han
- Department of Anestheiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Yeon Jung
- Department of Anestheiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Rho Yoon
- Department of Anestheiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Yong Chung
- Department of Anestheiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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5
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Chen Y, Zhang X. Acute Postobstructive Pulmonary Edema Following Laryngospasm in Elderly Patients: A Case Report. J Perianesth Nurs 2018; 34:250-258. [PMID: 30100095 DOI: 10.1016/j.jopan.2018.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/16/2018] [Accepted: 05/20/2018] [Indexed: 02/07/2023]
Abstract
Only a few cases regarding postobstructive pulmonary edema following laryngospasm in older patients aged more than 60 years have been reported; however, acute pulmonary edema or pulmonary hemorrhage would be more deadly to elderly patients who have cerebrovascular disease than young healthy adults. After review of the literature, we report an unusual case of a 67-year-old man with ischemic cerebrovascular disease, who underwent carotid angioplasty and stenting and experienced severe pulmonary edema and hemorrhage secondary to laryngospasm after general anesthesia with laryngeal mask airway. The patient required positive-pressure ventilation, supportive treatment, and active cerebroprotection in the intensive care setting for 3 days before the edema resolved, and subsequently made a complete recovery without new onset of neurologic sequelae. The possible pathophysiological mechanisms, precaution, and preventative strategy of postobstructive pulmonary edema in older patients are discussed.
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Lehnus K. Endotracheal tube obstruction with a blood clot following aspiration of rumen contents in a reindeer. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2018-000641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
SummaryAn apparently otherwise healthy female reindeer was anaesthetised for open reduction and fixation of a hip luxation. The animal developed ruminal bloat which was treated with passage of an orogastric tube that was left indwelling during the procedure. A fluid inspiratory noise was audible two hours after decompression, and clear fluid was suctioned from the airway. It showed no other signs of regurgitation and aspiration of rumen contents intraoperatively, and did not develop obvious respiratory compromise while mechanically ventilated. In recovery, the deer became apnoeic and cyanotic and died suddenly within minutes of being positioned in the recovery box. Just before dying, it coughed a large blood clot out of the endotracheal tube (ETT) . Additional clots were found partially obstructing the ETT lumen once extubated postmortem. Evidence of aspiration was detected at postmortem examination, which also identified pulmonary haemorrhage.
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Contou D, Voiriot G, Djibré M, Labbé V, Fartoukh M, Parrot A. Clinical Features of Patients with Diffuse Alveolar Hemorrhage due to Negative-Pressure Pulmonary Edema. Lung 2017; 195:477-487. [PMID: 28455784 DOI: 10.1007/s00408-017-0011-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/24/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Diffuse alveolar hemorrhage (DAH) with negative-pressure pulmonary edema (NPPE) is an uncommon yet life-threatening condition. We aimed at describing the circumstances, clinical, radiological, and bronchoscopic features, as well as the outcome of patients with NPPE-related DAH. METHODS We performed a retrospective, observational cohort study, using data prospectively collected over 35 years in an intensive care unit (ICU). RESULTS Of the 149 patients admitted for DAH, we identified 18 NPPE episodes in 15 patients, one admitted four times for recurrent NPPE-related DAH. The patients were primarily young, male, and athletic. The NPPE setting was postoperative (n = 12/18, 67%) or following generalized tonic-clonic seizures (n = 6/18, 33%). Hemoptysis was almost constant (n = 17/18, 94%), yet rarely massive (>200 cc, n = 1/18, 6%), with anemia observed in 10 (56%) episodes. The DAH triad (hemoptysis, anemia, and pulmonary infiltrates) was observed in 50% of episodes (n = 9/18), and acute respiratory failure in 94% (n = 17/18). Chest computed tomography revealed diffuse bilateral ground glass opacities (n = 10/10, 100%), while bronchoscopy detected bilateral hemorrhage (n = 12/12, 100%) and macroscopically bloody bronchoalveolar lavage, with siderophage absence in most (n = 7/8, 88%), indicating acute DAH. While one episode proved fatal, the other 17 recovered rapidly, with a mean ICU stay lasting 4.6 (2-15) days. Typically, the evolution was rapidly favorable under supportive care. CONCLUSION NPPE-related DAH is a rare life-threatening condition occurring primarily after tonic-clonic generalized seizure or generalized anesthesia. Clinical circumstances are a key to its diagnosis. Early diagnosis and recognition likely allow for successful management of this potentially serious complication, whereas ictal-DAH appears ominous in epileptic patients.
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Affiliation(s)
- Damien Contou
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. .,Réanimation Polyvalente, Hôpital Victor Dupouy, 69 Rue du Lieutenant Colonel Prudhon, 95100, Argenteuil, France.
| | - Guillaume Voiriot
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Michel Djibré
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Vincent Labbé
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Muriel Fartoukh
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Antoine Parrot
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
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8
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Bhattacharya M, Kallet RH, Ware LB, Matthay MA. Negative-Pressure Pulmonary Edema. Chest 2016; 150:927-933. [DOI: 10.1016/j.chest.2016.03.043] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 01/11/2023] Open
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9
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Aknin S, Frappart M, Berguiga R, Malinovsky JM. Hémoptysie et œdème aigu du poumon à pression négative en postopératoire d’une amygdalectomie. ACTA ACUST UNITED AC 2014; 33:178-80. [DOI: 10.1016/j.annfar.2013.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 12/19/2013] [Indexed: 02/07/2023]
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10
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Singh S, Nakra M, Shankar K A, Jacob M. Recurrent negative pressure pulmonary oedema after tracheal extubation. Med J Armed Forces India 2012; 70:383-5. [PMID: 25382916 DOI: 10.1016/j.mjafi.2012.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 05/07/2012] [Indexed: 10/27/2022] Open
Affiliation(s)
- Shalendra Singh
- Graded Specialist (Anaesthesia), Command Hospital (NC), Udhampur, India
| | - Monish Nakra
- Senior Advisor (Anaesthesia and Trained in Critical Care), Base Hospital, Delhi Cantt-10, India
| | - Anand Shankar K
- Classified Specialist (Anaesthesia), Command Hospital (NC), Udhampur, India
| | - Mathews Jacob
- Associate Professor, Dept of Anaesthesia, AFMC, Pune-40, India
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11
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Vandse R, Kothari DS, Tripathi RS, Lopez L, Stawicki SPA, Papadimos TJ. Negative pressure pulmonary edema with laryngeal mask airway use: Recognition, pathophysiology and treatment modalities. Int J Crit Illn Inj Sci 2012; 2:98-103. [PMID: 22837897 PMCID: PMC3401823 DOI: 10.4103/2229-5151.97275] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Negative pressure pulmonary edema (NPPE) following the use of the laryngeal mask airway (LMA) is an uncommon and under-reported event. We present a case of a 58-year-old male, who developed NPPE following LMA use. After biting vigorously on his LMA, the patient developed stridor upon emergence, with concurrent appearance of blood-tinged, frothy sputum and pulmonary edema. He subsequently required three days of mechanical ventilation. After discontinuation of mechanical ventilation the patient continued to require additional pulmonary support using continuous positive airway pressure, with a full facemask, to correct the persistent hypoxemia. His roentgenographic findings demonstrated an accelerated improvement with judicious administration of intravenous furosemide.
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Affiliation(s)
- Rashmi Vandse
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, Ohio, USA
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12
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Abstract
An African-American man, aged 34 years, underwent an elective uncomplicated right wrist laceration repair while under general anesthesia. Following extubation, the patient developed hypoxemia, tachypnea, shortness of breath, pulmonary rales, frothy sputum, decreased oxygen saturation, and evidence of upper airway obstruction. Chest radiograph showed pulmonary edema. The patient was diagnosed with post-extubation pulmonary edema (aka. negative pressure pulmonary edema [NPPE]) and was treated with intravenous furosemide and oxygen therapy; he improved remarkably within a few hours. Once stabilized, the patient described a similar episode 10 years earlier following surgery for multiple gunshot wounds. Negative pressure pulmonary edema following tracheal extubation is an uncommon (0.1%) and life-threatening complication of patients undergoing endotracheal intubation and general anesthesia for surgical procedures. The common pattern in these cases is the occurrence of an episode of airway obstruction upon emergence from general anesthesia, usually caused by laryngospasm. Patients who are predisposed to airway obstruction may have an increased risk of airway complications upon extubation after general anesthesia. Prevention and early relief of upper airway obstruction should decrease incidence. Recurrent NPPE has not been previously described in the literature. Herein, we describe the first case of recurrent NPPE in the same patient following extubation.
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Affiliation(s)
- Vikas Pathak
- Department of General Internal Medicine, Marshfield Clinic, WI 54449, USA.
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13
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Negative-pressure acute tracheobronchial hemorrhage and pulmonary edema. J Anesth 2009; 23:417-20. [PMID: 19685125 DOI: 10.1007/s00540-009-0757-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 02/26/2009] [Indexed: 12/19/2022]
Abstract
Negative-pressure pulmonary edema is a well-known complication of an acute upper airway obstruction, which may rarely present as acute alveolar hemorrhage in cases of severe capillary stress failure. Hemorrhage from the central airways has also been reported as a rare manifestation of acute tracheobronchial injury, associated with severe disruption of the bronchial vasculature due to highly negative inspiratory pressure. In this clinical report, we describe a case of both acute tracheobronchial and alveolar hemorrhage in a young man, occurring immediately after extubation due to laryngospasm, diagnosed by bronchoscopy with bronchoalveolar lavage (BAL), measurement of the pulmonary edema fluid/plasma protein ratio, and by thoracic computed tomography (CT) scan. We propose that the patient experienced severe postobstructive negative-pressure pulmonary edema, related to increased permeability of the alveolar capillary membrane and a parallel loss of integrity of the bronchial vascular network. Our findings suggest that both changes in the bronchial circulation and mechanical stress failure of the more distal alveolar-capillary system may be induced by severe and acute upper-airway obstruction.
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14
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Lee SK, Jung SH, Im JS, Chang DJ, Park JH, Kim YM, Moon HS. Pulmonary hemorrhage accompanied with pulmonary edema induced by endotracheal tube occlusion in a child: A case report. Korean J Anesthesiol 2009; 57:641-643. [PMID: 30625939 DOI: 10.4097/kjae.2009.57.5.641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Negative pressure induced pulmonary edema due to upper airway obstruction is a well-recognized problem. However, negative pressure pulmonary hemorrhage is extremely uncommon. We report a child who developed negative pressure pulmonary hemorrhage following acute airway obstruction caused by clench of endotracheal tube during emergence of anesthesia. The patient was treated with positive pressure ventilation and frequent tracheal suction. Hemorrhage from endotracheal tube was gradually decreased after 4 hours. The patient was extubated after 7 hours.
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Affiliation(s)
- Soo Kyung Lee
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Anyang, Korea.
| | - Seung Hwan Jung
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Anyang, Korea.
| | - Jong Sung Im
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Anyang, Korea.
| | - Dong Jin Chang
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Anyang, Korea.
| | - Ji Hyun Park
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Anyang, Korea.
| | - Young Mi Kim
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Anyang, Korea.
| | - Hyun Soo Moon
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Anyang, Korea.
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15
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Rodríguez Losada M, Tato Arias MR, López Piñeiro S, Moreno López E. [Pulmonary bleeding in negative-pressure pulmonary edema]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:59-60. [PMID: 19284136 DOI: 10.1016/s0034-9356(09)70329-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
UNLABELLED Sudden severe upper-airway obstruction occurring in a hospital setting can sometimes precipitate an episode of acute haemorrhagic pulmonary oedema. A review of 197 published case reports shows that the presenting feature is almost always the sudden appearance of blood stained fluid coming up through the larynx or out through the mouth and nose of an adult or child in obvious respiratory distress. Such overt features are seen in 10-15% of cases of sudden severe, but sub-lethal, upper-airway obstruction. Signs normally appear within minutes once the obstruction is relieved but are occasionally only recognized after 1-4 h. All signs and symptoms usually resolve within 12-24 h. Other causes of acute pulmonary haemorrhage are rare in young children. CONCLUSION If what looks like blood is seen in, or coming from, the mouth or nose of a previously healthy young child who has suddenly become distressed and started to struggle for breath, that child has most probably suffered an episode of acute pulmonary oedema, and the commonest precipitating cause is sudden upper-airway obstruction.
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17
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Mussi RK, Toro IFC. Edema e hemorragia pulmonar por pressão negativa associados à obstrução das vias aéreas superiores. J Bras Pneumol 2008; 34:420-4. [DOI: 10.1590/s1806-37132008000600013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Accepted: 08/08/2007] [Indexed: 11/22/2022] Open
Abstract
O edema pulmonar por pressão negativa associado à hemorragia como manifestação de obstrução das vias aéreas superiores é um problema incomum com potencial risco de morte. O principal mecanismo fisiopatológico envolvido é a geração de uma acentuada pressão negativa intratorácica que eleva tanto o volume vascular como a pressão transmural capilar pulmonar, causando risco de ruptura da membrana alvéolo-capilar. Relatamos o caso de um paciente do sexo masculino com hemorragia alveolar difusa após obstrução aguda das vias aéreas superiores causada pela formação de um abscesso cervical e mediastinal decorrente do implante de uma órtese traqueal metálica. O paciente foi tratado com drenagem do abscesso, antibioticoterapia e ventilação mecânica com pressão positiva. Este artigo enfatiza a importância de incluir essa entidade no diagnóstico diferencial da lesão pulmonar aguda após procedimentos que envolvam a manipulação das vias aéreas superiores.
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Idabouk L, Minville V, Salau S, Castel A, Franchitto N, Pourrut JC. Œdème pulmonaire après une arthroscopie du genou. ACTA ACUST UNITED AC 2006; 25:1007-10. [PMID: 16891092 DOI: 10.1016/j.annfar.2006.03.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Accepted: 03/28/2006] [Indexed: 10/24/2022]
Abstract
Negative pressure pulmonary oedema is one form of non cardiogenic pulmonary oedema that can occur following any general anaesthesia in which the patient was intubated. This complication can be severe, resulting in death/life-threatening if not diagnosed and treated promptly. We report a case of negative pressure pulmonary oedema, in a 26-year-old man, secondary to inspiratory effort with laryngeal spasm. Patient was transferred to intensive care unit for monitoring and non invasive ventilation. Prevention, early diagnosis, and prompt treatment allowed a rapid and uncomplicated resolution.
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Affiliation(s)
- L Idabouk
- Département d'anesthésie et de réanimation, CHU de Toulouse, université Paul-Sabatier, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 09, France
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19
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Remy C, Parrot A, Lembert N, Marret E, Bonnet F. [Haemoptysis after anesthesia]. ACTA ACUST UNITED AC 2006; 25:895-8. [PMID: 16859878 DOI: 10.1016/j.annfar.2006.03.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Accepted: 03/30/2006] [Indexed: 10/24/2022]
Abstract
Postobstructive pulmonary oedema is a complication after extubation that occurs rarely . It can be associated with haemoptysis. We report two cases of haemoptysis occuring in ASA 1 otherwise healthy patients who underwent uncomplicated anaesthesia. Understanding of the mechanism and prompt treatment lead to rapid recovery of this dramatic complication.
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Affiliation(s)
- C Remy
- Service d'Anesthésie-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
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Sickmann K, Seider R, Dahm M, Nold H. [Negative pressure pulmonary edema. Post-obstructive lung edema after use of a laryngeal mask]. Anaesthesist 2005; 54:1197-200. [PMID: 16132936 DOI: 10.1007/s00101-005-0913-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 31-year-old male patient was scheduled for surgical treatment of a distal radius fracture under general anaesthesia using a laryngeal mask airway and spontaneous ventilation. The intraoperative course was uneventful. During recovery, the patient strongly bit the laryngeal mask, producing a complete obstruction of the artificial airway in combination with very forceful inspiratory efforts until the mask was removed. In the recovery room the patient developed dyspnea and desaturation. A portable chest radiograph demonstrated bilateral alveolar infiltration suggesting pulmonary edema. The patient was transferred to the intensive care unit where drug therapy (furosemide and hydrocortisone) and treatment with the continuous flow continuous positive airway pressure (CF-CPAP) system led to complete recovery within 24 h.
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Affiliation(s)
- K Sickmann
- Institut für Anästhesie und Intensivmedizin, Klinikum des Landkreises Deggendorf, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Hannover, Perlasberger Strasse 41, 94469 Deggendorf.
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21
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Ciavarro C, Kelly JPW. Postobstructive pulmonary edema in an obese child after an oral surgery procedure under general anesthesia: a case report. J Oral Maxillofac Surg 2002; 60:1503-5. [PMID: 12465019 DOI: 10.1053/joms.2002.36147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Cesare Ciavarro
- Oral and Maxillofacial Surgery, Hospital of St Raphael, New Haven, CT 06511, USA
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22
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Shulman GB, Connelly NR. Bilateral pneumothoraces in a pediatric patient undergoing Hickman catheter placement. Anesth Analg 2002; 95:1251-2, table of contents. [PMID: 12401605 DOI: 10.1097/00000539-200211000-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPLICATIONS The laryngeal mask airway (LMA) is often used for airway management in pediatric patients. We report bilateral pneumothoraces in a patient who underwent neck surgery whose airway was managed with a LMA. We recommend that the LMA be used with caution in small children undergoing deep-neck dissection.
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Affiliation(s)
- G Brent Shulman
- Department of Anesthesiology, Marshfield Clinic, Marshfield, WI, USA
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23
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Banchereau F, Marié S, Pez H, Boully-Balihaut A, Tueux O. [Acute pulmonary edema from inhalation of the bite-block after anesthesia with a laryngeal mask]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2001; 20:865-8. [PMID: 11803848 DOI: 10.1016/s0750-7658(01)00511-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a case of acute pulmonary oedema, consecutive to upper airway obstruction due to the inhalation of the laryngeal mask airway (LMA) bite block during recovery. The LMA was used for general anaesthesia with the bite-block provided in France. No trouble occurred during LMA insertion and anaesthesia. Symptomatic treatment provided complete resolution within a few days.
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Affiliation(s)
- F Banchereau
- Département d'anesthésie-réanimation I, centre hospitalier universitaire, groupe Pellegrin, Place Amélie Raba-Léon, 33000 Bordeaux, France
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24
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Sow Nam Y, Garewal D. Pulmonary hemorrhage in association with negative pressure edema in an intubated patient. Acta Anaesthesiol Scand 2001; 45:911-3. [PMID: 11472296 DOI: 10.1034/j.1399-6576.2001.045007911.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Negative pressure pulmonary edema due to upper airway obstruction following extubation is a well-recognized problem. However, frank pulmonary hemorrhage as a manifestation of upper airway obstruction is uncommon. We report a case of significant pulmonary hemorrhage and negative pressure pulmonary edema in an intubated patient. Bronchoscopy showed a collection of blood in the right lower lobe of the lungs, suggesting a localized source of bleeding. There have been two previously reported cases of pulmonary hemorrhage after upper airway obstruction. One suggested that the bleeding was due to damage to the pulmonary capillaries, the other that it was due to disruption of the bronchial vessels. We feel that in our case there was some indication that the pulmonary bleeding was a result of bronchial vessel damage. A number of factors might have been involved in its development, including negative pulmonary pressure, recent respiratory tract infection, and positive airways pressure (due to coughing).
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Affiliation(s)
- Y Sow Nam
- Department of Anaesthesia and Intensive Care, Singapore General Hospital, Republic of Singapore
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25
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Uejima T. General pediatric emergencies. Acute pulmonary edema. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2001; 19:383-9, viii. [PMID: 11469070 DOI: 10.1016/s0889-8537(05)70234-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article focuses on three types of acute pulmonary edema in children: negative-pressure pulmonary edema, neurogenic pulmonary edema, and cardiogenic pulmonary edema.
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Affiliation(s)
- T Uejima
- Department of Anesthesia, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois, USA
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26
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Broccard AF, Liaudet L, Aubert JD, Schnyder P, Schaller MD. Negative pressure post-tracheal extubation alveolar hemorrhage. Anesth Analg 2001; 92:273-5. [PMID: 11133644 DOI: 10.1097/00000539-200101000-00055] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A F Broccard
- Division of Intensive Care (Service B), Department of Medicine, University Hospital Lausanne, Switzerland.
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27
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Abstract
Six cases of post-extubation pulmonary oedema in otherwise healthy patients are reported. All were preceded by an episode of laryngospasm and followed a clinical course similar to that previously documented in cases of post-obstructive pulmonary oedema. Frank haemoptysis was a feature of five of the presentations. One patient was reintubated and ventilated, two were admitted to the intensive care unit for mask CPAP, one was managed with CPAP in the recovery ward and two with supplemental oxygen only. All cases resolved fully within 24 hours. Some evidence points to the syndrome being the result of airway bleeding rather than true pulmonary oedema. The literature suggests that it occurs more commonly than is generally thought, with a frequency of 0.05 to 0.1% of all anaesthetics, and is often unrecognised or misdiagnosed. Most cases occur in the early postoperative period, so anaesthetists are well placed to witness, investigate and manage this interesting condition.
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Affiliation(s)
- P P McConkey
- Department of Anaesthesia, Intensive Care and Pain Management, John Hunter Hospital, Newcastle, New South Wales
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28
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Devys JM, Balleau C, Jayr C, Bourgain JL. Biting the laryngeal mask: an unusual cause of negative pressure pulmonary edema. Can J Anaesth 2000; 47:176-8. [PMID: 10674514 DOI: 10.1007/bf03018856] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To describe negative pressure pulmonary edema due to biting of the laryngeal mask tube at emergence from general anesthesia. CLINICAL FEATURES A healthy patient underwent general anesthesia using a laryngeal mask airway and mechanical ventilation. During recovery, the patient strongly bit the laryngeal mask and made very forceful inspiratory efforts until the mask was removed. Five minutes later, the patient developed dyspnea and had an hemoptysis of 50 ml fresh blood. Chest radiograph showed bilateral alveolar infiltrates. Pharyngo-laryngeal examination was normal. Bronchoscopy revealed no injury but diffuse pink frothy edema fluid. Clinical examination and chest radiograph became normal after 12 hr of nasal oxygen therapy confirming airway obstruction as the most available cause of this pulmonary edema. CONCLUSION Airway obstruction due to biting of a laryngeal mask tube may result in negative pressure pulmonary edema.
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Affiliation(s)
- J M Devys
- Département d'Anesthésie, Institut Gustave Roussy, Villejuif, France
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29
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Brandstetter RD. Liver transplantation: a critical care physician's personal odyssey. Chest 1999; 116:789-91. [PMID: 10492287 DOI: 10.1378/chest.116.3.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- R D Brandstetter
- Department of Medicine, Sound Shore Medical Center of Westchester, New Rochelle, NY 10802, USA
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30
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Abstract
Negative pressure pulmonary edema, a well-recognized phenomenon, is the formation of pulmonary edema following an acute upper airway obstruction (UAO). To our knowledge, diffuse alveolar hemorrhage has not been reported previously as a complication of an UAO. We describe a case of negative pressure pulmonary hemorrhage, and we propose that its etiology is stress failure, the mechanical disruption of the alveolar-capillary membrane.
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Affiliation(s)
- D R Schwartz
- Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston 02114-2696, USA.
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Abstract
A four-year-old boy was admitted to intensive care via casualty having suffered an apnoeic episode due to compression of his chest by a heavy cattle bar. A petechial rash was noted on the upper chest and arms. A chest radiograph showed pulmonary oedema which resolved over a few hours following positive pressure ventilation and positive end expiratory pressure. We believe this to be an unusual presentation of obstructive pulmonary oedemia (Negative Pressure Pulmonary Oedema).
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Affiliation(s)
- P J Dillon
- Royal Manchester Children's Hospital, Pendlebury, UK
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