Negative-pressure pulmonary edema


  • 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 an 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





  • 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


  • Admission for continued monitoring often if not always in the ICU

See Also

External Links


  1. Bhattacharya M, Kallet RJ, Ware LB, Matthay MA. Negative-pressure pulmonary edema. Chest. 2016;150(4):927-33.
  2. 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.