title: [Negative pressure pulmonary edema after tracheal extubation: case report].
abstract: OBJECTIVE
  Negative pressure pulmonary edema after acute upper airway obstruction is a well-described event, thought infrequently diagnosed and reported. This report aimed at presenting a case of postextubation negative pressure pulmonary edema refractory to use of diuretics and with successful therapeutic after using positive pressure noninvasive mechanic ventilation.
  
  
  METHODS
  A 22-year-old-woman underwent an operation to opened colecistectomy. The preoperative exams were abnormality us. Immediately after the extubation the patient presented with dyspnea and lungs stertors. The treatment for the acute pulmonary edema started with oxygen therapy under Venturi mask, lifting up chest and diuretic. The patient was transferred to Intensive Care Unit due to the lack of success with the treatment. A noninvasive ventilation (NIV) was started with support pressure of 15 cmH2O and PEEP of 5 cmH2O with resolution of symptoms. The patient was maintained under observation for 24 hours after the event with good conditions and received discharge to room without symptoms.
  
  
  CONCLUSIONS
  Negative pressure pulmonary edema (NPPE) is a difficult diagnosed event and it must be always considered when patient develop with symptoms and signals of respiratory insufficiency postextubation. In our case was possible to treat with positive pressure non-invasive mechanical ventilation, but in case of the NIV failure the tracheal intubation and the invasive mechanical ventilatory support be initiated to improve the oxygen levels of the patient.
authors.affiliation: Clínica Santa Juliana, Alagoas.
authors.forename: Fabiano Timbó
authors.initials: FT
authors.lastname: Barbosa
authors.affiliation: Hospital da Agroindústria do Açúcar e do Álcool do Estado de Alagoas.
authors.forename: Luciano Timbó
authors.initials: LT
authors.lastname: Barbosa
authors.affiliation: Anestesiologia, CET, Instituto Materno Infantil, Pernambuco.
authors.forename: Jadielson Higino de
authors.initials: JH
authors.lastname: Almeida
authors.affiliation: Medicina, Universidade Federal de Alagoas.
authors.forename: Kleyner Leão Gomes da
authors.initials: KL
authors.lastname: Silva
authors.affiliation: Medicina, Universidade Federal de Alagoas.
authors.forename: Roberta Ribeiro Marques
authors.initials: RR
authors.lastname: Brandão
authors.affiliation: Medicina, Universidade Federal de Alagoas.
authors.forename: Leyna Leite
authors.initials: LL
authors.lastname: Santos