Negative pressure pulmonary edema: Difference between revisions

(Text replacement - "Category:Pulm" to "Category:Pulmonary")
No edit summary
 
(2 intermediate revisions by 2 users not shown)
Line 3: Line 3:
*Forced inspiration against obstructed airway causes large negative intrathoracic pressure, leading to pulmonary edema<ref>Bhaskar B, Fraser JF. Negative pressure pulmonary edema revisited: Pathophysiology and review of management. Saudi J Anaesth. 2011 Jul-Sep; 5(3): 308–313.</ref>
*Forced inspiration against obstructed airway causes large negative intrathoracic pressure, leading to pulmonary edema<ref>Bhaskar B, Fraser JF. Negative pressure pulmonary edema revisited: Pathophysiology and review of management. Saudi J Anaesth. 2011 Jul-Sep; 5(3): 308–313.</ref>
*Mostly due to postoperative laryngospasm, sudden drops in PEEP (high PEEP to manual BVM), trauma such as hanging, strangulation, foreign bodies, etc.
*Mostly due to postoperative laryngospasm, sudden drops in PEEP (high PEEP to manual BVM), trauma such as hanging, strangulation, foreign bodies, etc.
*The negative pressure causes hydrostatic edema that can be life-threatening if not but minimized if treated early, usually resolves after 24-48 hours. <ref>Bhattacharya M, Kallet RJ, Ware LB, Matthay MA. Negative-pressure pulmonary edema. Chest. 2016;150(4):927-33. </ref>
*Patients have an airway obstructive process either from an allergy, laryngospasm, trauma, and commonly in the case of [[hangings]].<ref>Contou D, Voiriot G, Djibre et al. Clinical features of patients with diffuse alveolar hemorrhage due to negative-pressure pulmonary edema. Lung. 2017;195(4):477-487. </ref>


==Clinical Presentation==
==Clinical Features==
*[[Hypoxemia]] (may be sudden and large - beware "fake" or "not real" SpO2), stridor, retractions, accessory muscle use, crackles/wheezes
*[[Hypoxemia]] (may be sudden and large - beware "fake" or "not real" SpO2), stridor, retractions, accessory muscle use, crackles/wheezes
*[[CXR]] shows diffuse interstitial and alveolar infiltrates
{{Pulmonary edema clinical features}}
*CT shows preferential central/nondependent distribution of edema (as opposed to other forms of pulmonary edema)


==Differential Diagnosis==
==Differential Diagnosis==
{{Pulmonary edema types}}
{{Pulmonary edema types}}


==Diagnosis==
==Evaluation==
*[[CXR]] shows diffuse interstitial and alveolar infiltrates
*CT shows preferential central/nondependent distribution of edema (as opposed to other forms of pulmonary edema)


==Management==
==Management==
*Relieve airway obstruction
*Relieve airway obstruction/obstructive processes
*Vent with generous PEEP and diuretics
*Vent with generous PEEP and diuretics
*[[Intubation]] is often required
*Patients with severe pulmonary edema that do not respond to standard ventilator strategies may require proning or even [[ECMO]]


==Disposition==
==Disposition==
*Admit, often ICU


==See Also==
==See Also==
Line 29: Line 35:


[[Category:Pulmonary]]
[[Category:Pulmonary]]
[[Category:Critical Care]]

Latest revision as of 20:21, 12 October 2019

Background

  • Also known as post-obstructive pulmonary edema
  • Forced inspiration against obstructed airway causes large negative intrathoracic pressure, leading to pulmonary edema[1]
  • Mostly due to postoperative laryngospasm, sudden drops in PEEP (high PEEP to manual BVM), trauma such as hanging, strangulation, foreign bodies, etc.
  • The negative pressure causes hydrostatic edema that can be life-threatening if not but minimized if treated early, usually resolves after 24-48 hours. [2]
  • Patients have an airway obstructive process either from an allergy, laryngospasm, trauma, and commonly in the case of hangings.[3]

Clinical Features

  • Hypoxemia (may be sudden and large - beware "fake" or "not real" SpO2), stridor, retractions, accessory muscle use, crackles/wheezes
  • Crackles
  • Respiratory distress
  • Increased jugular venous distension
  • Signs of poor organ perfusion

Differential Diagnosis

Pulmonary Edema Types

Pulmonary capillary wedge pressure <18 mmHg differentiates noncardiogenic from cardiogenic pulmonary edema[4]

Evaluation

  • CXR shows diffuse interstitial and alveolar infiltrates
  • CT shows preferential central/nondependent distribution of edema (as opposed to other forms of pulmonary edema)

Management

  • Relieve airway obstruction/obstructive processes
  • Vent with generous PEEP and diuretics
  • Intubation is often required
  • Patients with severe pulmonary edema that do not respond to standard ventilator strategies may require proning or even ECMO

Disposition

  • Admit, often ICU

See Also

External Links

References

  1. Bhaskar B, Fraser JF. Negative pressure pulmonary edema revisited: Pathophysiology and review of management. Saudi J Anaesth. 2011 Jul-Sep; 5(3): 308–313.
  2. Bhattacharya M, Kallet RJ, Ware LB, Matthay MA. Negative-pressure pulmonary edema. Chest. 2016;150(4):927-33.
  3. Contou D, Voiriot G, Djibre et al. Clinical features of patients with diffuse alveolar hemorrhage due to negative-pressure pulmonary edema. Lung. 2017;195(4):477-487.
  4. Clark SB, Soos MP. Noncardiogenic Pulmonary Edema. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 1, 2020.