title: Negative-pressure pulmonary edema: a rare complication of upper airway obstruction in children.
abstract: Negative-pressure pulmonary edema is a rare but life-threatening complication of upper airway obstruction. Because negative-pressure pulmonary edema may occur in a large spectrum of pathologies associated with upper airway obstruction, awareness of this condition is crucial during daily clinical practice. We report a case of negative-pressure pulmonary edema during anesthetic recovery to highlight this condition.
  
  
  METHODS
  A 2-year-old boy was scheduled for orchidopexy under general anesthesia. Shortly after an uneventful operation, the patient presented airway obstruction. Serious oxygen desaturation and bradycardia ensued, during inefficient attempts at positive-pressure ventilation. After emergency intubation, copious pink secretions emerged from the airway. Pulmonary edema was confirmed by clinical examination, pulse oximetry, and chest radiography. The finding of pulmonary edema was resolved within 24 hours after mechanical ventilation and positive end-expiratory pressure. The child suffered no sequelae. This report highlights the clinical features of negative-pressure pulmonary edema and serves as a reminder to the pediatrician who must be able to recognize and initiate treatment for conditions that are uncommon but life-threatening.
authors.affiliation: Department of Pediatric Intensive Care Unit, Hospital Estadual de Diadema, Universidade Federal de São Paulo, São Paulo, Brazil. psls.nat@ig.com.br
authors.forename: Paulo Sérgio Lucas da
authors.initials: PS
authors.lastname: Silva
authors.forename: Henrique
authors.initials: H
authors.lastname: Monteiro Neto
authors.forename: Márcia Midori Takeuchi
authors.initials: MM
authors.lastname: Andrade
authors.forename: Carla Vieira de Mattos
authors.initials: CV
authors.lastname: Neves
mesh_terms: D000402:Airway Obstruction / Q000150:complications*; D001919:Bradycardia / Q000209:etiology; D002675:Child, Preschool; D020878:Device Removal; D005122:Exudates and Transudates; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007826:Laryngismus / Q000150:complications*; D008297:Male; D008397:Masks; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications / Q000209:etiology*; D011312:Pressure; D011654:Pulmonary Edema / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D013737:Testis / Q000601:surgery