Negative-pressure pulmonary edema
Background
- Negative-pressure pulmonary edema (NPPE) occurs after a patient makes strong inspiratory effort against a blocked airway. The negative pressure causes hydrostatic edema that can be life-threatening if not but minimized if treated early, usually resolves after 24-48 hours. [1]
- Patients have and airway obstructive process either from an allergy, laryngospasm, trauma, and commonly in the case of hangings.[2]
Clinical Features
- Crackles
- Respiratory distress
- Increased jugular venous distension
- Signs of poor organ perfusion
Differential Diagnosis
Acute dyspnea
Emergent
- Pulmonary
- Airway obstruction
- Anaphylaxis
- Angioedema
- Aspiration
- Asthma
- Cor pulmonale
- Inhalation exposure
- Noncardiogenic pulmonary edema
- Pneumonia
- Pneumocystis Pneumonia (PCP)
- Pulmonary embolism
- Pulmonary hypertension
- Tension pneumothorax
- Idiopathic pulmonary fibrosis acute exacerbation
- Cystic fibrosis exacerbation
- Cardiac
- Other Associated with Normal/↑ Respiratory Effort
- Other Associated with ↓ Respiratory Effort
Non-Emergent
- ALS
- Ascites
- Uncorrected ASD
- Congenital heart disease
- COPD exacerbation
- Fever
- Hyperventilation
- Interstitial lung disease
- Neoplasm
- Obesity
- Panic attack
- Pleural effusion
- Polymyositis
- Porphyria
- Pregnancy
- Rib fracture
- Spontaneous pneumothorax
- Thyroid Disease
- URI
Evaluation
Management
- Remove any obstructive processes
- Intubation is often required
- Positive pressure ventilation
- Patients with severe pulmonary edema that do not respond to standard ventilator strategies may require proning or even ECMO
Disposition
- Admission for continued monitoring often if not always in the ICU