Negative pressure pulmonary edema after acute upper airway obstruction.

STUDY OBJECTIVES: To review the clinical characteristics and the pathogenesis of negative pressure pulmonary edema, and to determine its incidence in surgical patients.

DESIGN: Retrospective case-report study.

SETTING: Operating room, postanesthesia care unit and surgical intensive care of a teaching hospital.

PATIENTS: 30 surgical adult ASA physical status I, II, III, IV, and V patients who suffered from negative pressure pulmonary edema during the period 1992-1995.

MEASUREMENTS AND MAIN RESULTS: This study showed a rapid onset of negative pressure pulmonary edema after acute upper airway obstruction, due mainly to laryngospasm in the postoperative period and to upper airway pathology in the preoperative period. Negative pressure pulmonary edema appeared more frequent in healthy (ASA physical status I and II), middle-aged and male patients, with a general incidence of 0.094%. The resolution was relatively rapid after reestablishment of the airway, adequate oxygenation, and positive airway pressure application. The clinical course was uncomplicated in all the patients.

CONCLUSIONS: In this study, negative pressure pulmonary edema presented a relatively high incidence. Prevention, early diagnosis, and prompt treatment allowed a rapid and uncomplicated resolution.