Acute Postoperative Negative Pressure Pulmonary Edema as Complication of Acute Airway Obstruction: Case Report

Acute postoperative negative pressure pulmonary edema (NPPE) is a respiratory complication due to acute airway obstruction (UAO) that occurs shortly after extubation of patients who under general anesthesia (incidence 0.05 to 0.1%) Usually, this complication develops in healthy young patients, capable of generating high negative intrathoracic pressures (NIP), which is the catalyst in the pathophysiological cascade of acute pulmonary edema. Commonly presents as acute respiratory distress that requires immediate intervention. We report a case of postoperative NPPE occurred immediately after tracheal extubation in an adult patient, who underwent a minor elective orthopedic surgery under general anesthesia. After extubation, UAO due to laryngospasm was observed and the patient started desaturating rapidly. Application of positive pressure via face mask ventilation (FiO2 100%) was unsuccessful in providing effective ventilation so we decided to reintubate the patient. Soon after reintubation, there were bilateral pulmonary rales and pink frothy secretion inside the tracheal tube, compatible with NPPE. Treatment was rapidly instituted with diuretic, corticosteroid and ventilator support with added PEEP. Pulmonary edema resolved completely after 6 hours later without any complications intensive care unit.