title: Negative-Pressure Pulmonary Edema.
abstract: Negative-pressure pulmonary edema (NPPE) or postobstructive pulmonary edema is a well-described cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed airway, usually from upper airway infection, tumor, or laryngospasm. Patients with NPPE generate very negative airway pressures, which augment transvascular fluid filtration and precipitate interstitial and alveolar edema. Pulmonary edema fluid collected from most patients with NPPE has a low protein concentration, suggesting hydrostatic forces as the primary mechanism for the pathogenesis of NPPE. Supportive care should be directed at relieving the upper airway obstruction by endotracheal intubation or cricothyroidotomy, institution of lung-protective positive-pressure ventilation, and diuresis unless the patient is in shock. Resolution of the pulmonary edema is usually rapid, in part because alveolar fluid clearance mechanisms are intact. In this review, we discuss the clinical presentation, pathophysiology, and management of negative-pressure or postobstructive pulmonary edema.
authors.affiliation: Departments of Medicine, Anesthesia, and Respiratory Care, University of California, San Francisco, San Francisco, CA.
authors.forename: Mallar
authors.initials: M
authors.lastname: Bhattacharya
authors.affiliation: Departments of Medicine, Anesthesia, and Respiratory Care, University of California, San Francisco, San Francisco, CA.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Kallet
authors.affiliation: Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN.
authors.forename: Lorraine B
authors.initials: LB
authors.lastname: Ware
authors.affiliation: Departments of Medicine, Anesthesia, and Respiratory Care, University of California, San Francisco, San Francisco, CA; Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA. Electronic address: michael.matthay@ucsf.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Matthay
mesh_terms: D000402:Airway Obstruction / Q000150:complications*; D001798:Blood Proteins / Q000378:metabolism; D002199:Capillary Permeability; D045604:Extracellular Fluid / Q000378:metabolism; D006801:Humans; D006874:Hydrostatic Pressure; D007442:Intubation, Intratracheal; D007826:Laryngismus / Q000150:complications; D011183:Postoperative Complications; D011654:Pulmonary Edema / Q000209:etiology* / Q000378:metabolism; D012131:Respiratory Insufficiency / Q000209:etiology*
chemical_list: D001798:Blood Proteins
keywords: acute lung injury; pulmonary edema