Case scenario: acute postoperative negative pressure pulmonary edema.

FORMATION of noncardiogenic pulmonary edema has been observed after a variety of inciting events, including upper airway obstruction (negative pressure pulmonary edema [NPPE]), acute lung injury, anaphylaxis, fluid maldistribution, and severe central nervous system trauma (neurogenic pulmonary edema). Both the diagnosis of pulmonary edema and an understanding of its underlying pathophysiology have important implications for treatment. Patients with severe postoperative noncardiogenic pulmonary edema who require mechanical ventilation should be ventilated with a low-tidal volume, administration of positive end-expiratory pressure, and low plateau airway pressures. Recent studies suggest that noninvasive respiratory support might be a viable approach for the treatment of patients with postoperative respiratory dysfunction, including postoperative NPPE.