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Negative pressure pulmonary edema
From WikEM
Contents
Background
- Also known as post-obstructive pulmonary edema
- Forced inspiration against obstructed airway causes large negative intrathoracic pressure, leading to pulmonary edema[1]
- Mostly due to postoperative laryngospasm, sudden drops in PEEP (high PEEP to manual BVM), trauma such as hanging, strangulation, foreign bodies, etc.
Clinical Features
- Hypoxemia (may be sudden and large - beware "fake" or "not real" SpO2), stridor, retractions, accessory muscle use, crackles/wheezes
- CXR shows diffuse interstitial and alveolar infiltrates
- CT shows preferential central/nondependent distribution of edema (as opposed to other forms of pulmonary edema)
Differential Diagnosis
Pulmonary Edema Types
Cardiogenic pulmonary edema
Noncardiogenic pulmonary edema
- Negative pressure pulmonary edema
- Upper airway obstruction
- Reexpansion edema
- Neurogenic causes
- Iatrogenic fluid overload
- Multiple blood transfusions
- IV fluid
- Inhalation injury
- Pulmonary contusion
- Aspiration pneumonia and pneumonitis
- Other
Evaluation
Management
- Relieve airway obstruction
- Vent with generous PEEP and diuretics
Disposition
See Also
External Links
References
- ↑ Bhaskar B, Fraser JF. Negative pressure pulmonary edema revisited: Pathophysiology and review of management. Saudi J Anaesth. 2011 Jul-Sep; 5(3): 308–313.
