Negative-pressure pulmonary edema with a patent airway.
Negative pressure is a rarely occurring cause of pulmonary edema. It has previously been reported only in the presence of a closed glottis or obstructed airway. A 64-year-old man with 74% body surface burn without any inhalation injury experienced acute pulmonary edema on hospital day 11 associated with high-minute volume and negative inspiratory pressures at the ventilator. The edema cleared after sedation and paralysis. Workup disclosed pulmonary emboli and normal cardiac-filling pressures. A mechanical model, simulating his breathing, measured intrathoracic pressure of -37 +/- 12 mm Hg, which is sufficiently negative to cause pulmonary edema despite a patent airway. Pulmonary emboli increased his respiratory drive to amounts greater than what the ventilator could deliver, thus leading to the large negative intrathoracic pressure and pulmonary edema.
Department of Anesthesiology, Saint Vincent Mercy Medical Center, Toledo, OH 43608-2691, USA.
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D002056:Burns / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D008961:Models, Structural; D011312:Pressure; D011654:Pulmonary Edema / Q000209:etiology* / Q000503:physiopathology; D013909:Thorax / Q000502:physiology; D012122:Ventilators, Mechanical