title: Noninvasive positive pressure ventilation in patients with perioperative negative pressure pulmonary edema.
abstract: Negative pressure pulmonary edema (NPPE) is a noncardiogenic pathological process that is treated with invasive ventilation via a tracheal tube. To investigate the feasibility and safety of noninvasive positive pressure ventilation (NPPV) as an alternative treatment for NPPE, we retrospectively reviewed charts of 15 perioperative NPPE patients. Eight patients were treated by NPPV and 7 were treated by invasive ventilation. Patient characteristics, duration of NPPV, duration of intensive care unit (ICU) stay, and maximum airway pressure were investigated for the NPPV-treated patients. All patients treated by NPPV had a patent airway after complete relief of the airway obstruction and recovered from NPPE symptoms within one postoperative day. Arterial blood gas analysis showed a significant improvement in the PaO(2)/FiO(2) ratio from 132 + or - 30 mmHg in the operating room to 282 + or - 77 mmHg at discontinuation of NPPV. Serious complications, such as ventilator-associated pneumonia or aspiration pneumonia, did not occur, and intubation was not required for any patient. Favorable outcomes in these cases suggest that NPPV could be a feasible and safe alternative for treating NPPE if the patency of the airway is restored.
authors.affiliation: Department of Anesthesiology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. s7078@nms.ac.jp
authors.forename: Masayuki
authors.initials: M
authors.lastname: Furuichi
authors.forename: Shinhiro
authors.initials: S
authors.lastname: Takeda
authors.forename: Shinji
authors.initials: S
authors.lastname: Akada
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Onodera
authors.forename: Yuko
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Keiko
authors.initials: K
authors.lastname: Nakazato
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Sakamoto
mesh_terms: D000138:Acidosis / Q000150:complications; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D003422:Critical Care; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D019990:Perioperative Care; D011175:Positive-Pressure Respiration / Q000009:adverse effects; D011654:Pulmonary Edema / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010100:Oxygen