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. 2014 Aug;40(8):1140-3.
doi: 10.1007/s00134-014-3307-7. Epub 2014 May 6.

Understanding negative pressure pulmonary edema

Malcolm Lemyze  1 , Jihad Mallat
Affiliations

Understanding negative pressure pulmonary edema

Malcolm Lemyze et al. Intensive Care Med. 2014 Aug.
No abstract available

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Figures

Fig. 1
Fig. 1
As shown in the left part of the illustration, breathing through the normally open upper airway requires minimal diaphragmatic efforts (thin black arrow) that generate small levels (−2 to −8 cmH2O) of negative pleural pressure (P PL) during inspiration. In normal conditions, the alveolar–capillary pressure gradient is small, and when hydrostatic pressures slightly increase in the pulmonary capillary bed, the fluid overload may be offset by increased lymphatic drainage. Conversely, inspiration against an obstructed upper airway—as represented by closed vocal cords in the right side of the illustration—requires forceful diaphragmatic efforts (large black arrow) generating high levels (−50 to −140 cmH2O) of negative P PL that increase venous return to the right side of the heart (large blue arrow). This may result in higher hydrostatic pressures in the pulmonary capillaries and a sudden drop of pressures in the alveolar spaces, creating a huge pressure gradient across the pulmonary capillary wall and disruption of the alveolar–capillary membrane, leading to alveolar flooding and pulmonary edema (yellow arrows)
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