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.
Engoren
M C
MC
Department of Anesthesiology, Saint Vincent Mercy Medical Center, Toledo, OH 43608-2691, USA.
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