NDLI: Edema pulmonar assimétrico por pressão negativa pós-obstrução de via aérea superior: relato de caso.

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Year: 2002 Volume: 52 Issue: 2

Edema pulmonar assimétrico por pressão negativa pós-obstrução de via aérea superior: relato de caso.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Peixoto, Aldo José
Description	Country affiliation: Brazil Author Affiliation: Peixoto AJ ( Departamento de Anestesiologia, Hospital de Caridade de Erechim, Brazil. peixoto@st.com.br)
Abstract	BACKGROUND AND OBJECTIVES: Negative pressure pulmonary edema after acute upper airway obstruction is a well-described event, though infrequently diagnosed and reported. This report aimed at presenting a case of upper airway obstruction negative pressure pulmonary edema following acute upper airway obstruction characterized by pulmonary edema asymmetry, being more prominent in the right lung. CASE REPORT: A 4-year-old boy, 17 kg, phisical status ASA I submitted to combined tonsillectomy, adenoidectomy and turbinate cauterization under general anesthesia with sevoflurane/nitrous oxide/O2. Surgery duration was 90 minutes without complications. During anesthetic recovery and spontaneously breathing, patient reacted to tracheal tube, which was removed. Following, ventilatory efforts resulted in chest wall retraction without apparent air movement, being impossible to ventilate him with facial mask. Symptoms evolved to severe hypoxemia (50% SpO2) requiring reintubation. At this point, it was observed that the lung was stiffer and there were bilateral rales characterizing pulmonary edema. A chest X-ray showed diffuse bilateral infiltrates, right upper lobe atelectasis and marked pulmonary edema asymmetry (right greater than left). Patient was mechanically ventilated with PEEP for 20 hours when he was extubated. There was a progressive pulmonary edema improvement and patient was discharged 48 hours later. CONCLUSIONS: Negative pressure pulmonary edema (NPPE) is a rare event with high morbidity risk. It is often not diagnosed and requires from the anesthesiologist an updated knowledge and adequate management. It is usually bilateral, rarely unilateral, and exceptionally asymmetric as in this case. Most cases are treated by mechanical ventilation with PEEP or CPAP without any other therapy. The prognosis is favorable, with most cases recovering within the first 24 hours.
File Format	HTM / HTML
ISSN	00347094
e-ISSN	1806907X
Journal	Brazilian Journal of Anesthesiology
Issue Number	3
Volume Number	52
Language	Portuguese
Publisher	Elsevier
Publisher Date	2002-06-01
Publisher Place	Brazil
Access Restriction	Open
Subject Keyword	Discipline Anesthesiology
Alternative Title	Asymmetric negative pressure pulmonary edema after acute upper airway obstruction: case report
Content Type	Text
Resource Type	Article

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