title: Negative pressure pulmonary edema following bronchospasm.
abstract: Negative pressure pulmonary edema (NPPE) is an important cause of noncardiogenic pulmonary edema but is rarely reported in the setting of bronchospasm. A 43-year-old woman with severe reactive airway disease suffered an episode of severe bronchospasm after endotracheal extubation following an otherwise uneventful general anesthetic. Subsequently, she developed clinical and radiographic signs of pulmonary edema in the absence of other symptoms of acute left-sided heart failure, leading to the diagnosis of noncardiogenic pulmonary edema. She received noninvasive positive pressure ventilation for a few hours, after which her clinical and radiologic signs and symptoms of pulmonary edema were greatly improved. This clinical scenario strongly suggests NPPE. We submit that it is possible to create NPPE by generating highly negative intrathoracic pressures in the setting of severe bronchospasm.
authors: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: dkrodel@partners.org.
authors: David J
authors: DJ
authors: Krodel
authors: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Edward A
authors: EA
authors: Bittner
authors: Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Raja-Elie E
authors: RE
authors: Abdulnour
authors: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Department of Environmental Health Sciences, Division of Physiology, Johns Hopkins University, Baltimore, MD; Department of Medicine, Division of Pulmonary Medicine, Johns Hopkins University, Baltimore, MD; Department of Radiology, Johns Hopkins University, Baltimore, MD.
authors: Robert H
authors: RH
authors: Brown
authors: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Matthias
authors: M
authors: Eikermann
mesh_terms: D000328:Adult; D001986:Bronchial Spasm / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D011175:Positive-Pressure Respiration; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed