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. 2025 Feb 27;11(1):13.
doi: 10.1186/s40981-025-00777-w.

Unexpected negative-pressure pulmonary edema after tracheostomy: two case reports

Taichi Kotani  1 , Yusuke Naito  2 , Chie Okuda  2 , Shota Sonobe  2 , Junji Egawa  2 , Masahiko Kawaguchi  2
Affiliations

Unexpected negative-pressure pulmonary edema after tracheostomy: two case reports

Taichi Kotani et al. JA Clin Rep. .

Abstract

Background: Negative-pressure pulmonary edema (NPPE) often develops with upper airway obstruction, and is uncommon in secured airways, for example, after tracheostomy. Herein, we report two cases of NPPE post-tracheostomy.

Case presentation: Case 1: A 69-year-old man underwent prophylactic tracheotomy for possible airway obstruction secondary to glottic carcinoma. Two hours after awakening from general anesthesia, he had difficulty expectorating and developed NPPE due to airway secretions obstructing the tracheostomy tube. Case 2: An 11-year-old boy was admitted to the intensive care unit for continuous hemodiafiltration on a ventilator under sedation. On the 76th day, the day after the tracheostomy was performed, the patient developed patient-ventilator asynchrony due to sedative withdrawal syndrome. The postulated primary mechanism was functional airway obstruction due to patient-ventilator asynchrony.

Conclusion: These cases highlight the need to consider NPPE, even in patients with an airway secured with a tracheostomy.

Keywords: Functional airway obstruction; Mechanical airway obstruction; Negative-pressure pulmonary edema; Tracheotomy; Withdrawal syndrome.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Written informed consent was obtained from the patients and their families to publish this case report and accompanying images. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Chest radiography images of Case 1. a At the onset of pulmonary edema after tracheostomy. b Forty-eight hours after onset and treatment of pulmonary edema
Fig. 2
Fig. 2
Chest radiography images of Case 2. a After tracheostomy with pulmonary edema. b Forty-eight hours after onset and treatment of pulmonary edema
See this image and copyright information in PMC

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