Severe postoperative negative pressure pulmonary edema: a case report

Abstract

Background: Postoperative negative pressure pulmonary edema (NPPE) can occur in any patient undergoing general anesthesia. There are several risk factors for it, especially postoperative laryngospasm. The disease is usually benign and quickly reversible. In our case the severity and need for advanced critical care therapy was unusual.

Case: We report a severe case of postoperative negative pressure pulmonary edema in a 62-year-old male patient undergoing elective right-sided retroperitoneoscopic adrenalectomy. The patient developed a severe case of acute respiratory distress syndrome (ARDS) after postoperative laryngospasm, possibly in conjunction with a suspected anaphylactic reaction. The patient was consequently treated with a combination of invasive airway pressure release ventilation (APRV) and a prone positioning regimen. After drastic improvement in respiratory function, the patient was discharged from the intensive care unit after 10 days and from the hospital after 14 days.

Conclusion: NPPE is a rare but relevant complication of anesthesia and laryngospasm. The disease can basically occur in any patient undergoing general anesthesia and therefore should be considered.

Keywords: APRV Ventilation Mode; ARDS; Intraoperative complications; Laryngospasm; Pulmonary edema.

Fig. 1

CT-scan with angiography of the thorax. Approximately 20 min post-intubution on postoperative day 0. Three transversal views from supradiaphragmal to apical (left). One sagittal view (right). Presence of severe alveolar interstitial bi-pulmonary edema. No signs of pulmonary artery embolism. Postoperative ventral subcutaneous emphysema

Fig. 2

Non-contrasted thoracic CT-scan, postoperative day 7. 3 transversal views from supradiaphragmal to apical (left). 1 sagittal view (right). Progredient consolidations of both upper lobs. Progredient bilateral pleura effusion