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Communications to the Editor |

Negative Pressure Pulmonary Edema as an Unsuspected Imitator of Acute Lung Injury/ARDS FREE TO VIEW

Gareth L. Ackland, PhD; Michael G. Mythen, MD
Author and Funding Information

University College London, London, UK

Correspondence to: Gareth L. Ackland, PhD, Centre for Anaesthesia, University College London, The Middlesex Hospital, Mortimer St, London W1T 8AA, UK; e-mail: g.ackland@rfc.ucl.ac.uk



Chest. 2005;127(5):1867-1868. doi:10.1378/chest.127.5.1867-a
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Published online

To the Editor:

Further to the recent review article by Schwarz and Albert1(April 2004), we would like to add negative pressure pulmonary edema (NPPE) as a further important imitator. NPPE may rarely fall into the category of diffuse alveolar hemorrhage (DAH) through damage of the pulmonary capillaries by mechanical disruption of the alveolar-capillary membrane, resulting in diffuse alveolar injury. More usually, pulmonary edema is manifest, with fulfillment of the clinical, physiologic, and radiographic criteria for acute lung injury (ALI)/ARDS. Several hypotheses have been postulated to explain the pathophysiologic sequelae of NPPE.25 While early recognition and specific treatment of an underlying condition29 may rule in NPPE or rule out other causes of DAH, an obvious underlying cause may be absent particularly after emergence from anesthesia or unwitnessed upper airway obstruction. Indeed, symptoms of NPPE may be considerably delayed after extubation.9Although symptoms usually resolve rapidly with restoration and/or maintenance of a patent airway and supplemental oxygen, positive end-expiratory pressure and mechanical ventilation may be required for a prolonged period of time.10 Failure to consider NPPE in the differential diagnosis of acute clinical, physiologic, and radiographic changes that fit the criteria for ALI/ARDS may lead to unnecessary and potentially deleterious iatrogenic complications.

Schwarz, MI, Albert, RK (2004) “Imitators” of the ARDS: implications for diagnosis and treatment.Chest125,1530-1535
 
Kollef, MH, Pluss, J Noncardiogenic pulmonary edema following upper airway obstruction.Medicine1991;70,91-98
 
Palvin, DJ, Nersley, ML, Cheney, FW Increased pulmonary vascular permeability as a cause of re-expansion pulmonary oedema.Am Rev Respir Dis1981;124,422-427
 
Shwartz, D, Maroo, A, Malhotra, A Negative pressure pulmonary haemorrhage.Chest1999;115,1194-1197
 
Lorch, DG, Sahn, SA Post-extubation pulmonary oedema following anaesthesia induced by upper airway obstruction: are certain patients at increased risk?Chest1986;90,802-805
 
Oswalt, CE, Gates, GA, Holmstrom, MG Pulmonary edema as a complication of acute airway obstruction.JAMA1977;238,1833-1835
 
Koh, MS, Hsu, AA, Eng, P Negative pressure pulmonary oedema in the medical intensive care unit.Intensive Care Med2003;29,1601-1604
 
Devys, JM, Balleau, C, Jayr, C, et al Biting the laryngeal mask: an unusual cause of negative pressure pulmonary edema.Can J Anaesth2000;47,176-178
 
Cascade, PN, Alexander, GD, Mackie, DS Negative-pressure pulmonary edema after endotracheal intubation.Radiology1993;186,671-675
 
Dolinski, SY, MacGregor, DA, Scuderi, PE Pulmonary hemorrhage associated with negative-pressure pulmonary edema.Anesthesiology2000;93,888-890
 

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Tables

References

Schwarz, MI, Albert, RK (2004) “Imitators” of the ARDS: implications for diagnosis and treatment.Chest125,1530-1535
 
Kollef, MH, Pluss, J Noncardiogenic pulmonary edema following upper airway obstruction.Medicine1991;70,91-98
 
Palvin, DJ, Nersley, ML, Cheney, FW Increased pulmonary vascular permeability as a cause of re-expansion pulmonary oedema.Am Rev Respir Dis1981;124,422-427
 
Shwartz, D, Maroo, A, Malhotra, A Negative pressure pulmonary haemorrhage.Chest1999;115,1194-1197
 
Lorch, DG, Sahn, SA Post-extubation pulmonary oedema following anaesthesia induced by upper airway obstruction: are certain patients at increased risk?Chest1986;90,802-805
 
Oswalt, CE, Gates, GA, Holmstrom, MG Pulmonary edema as a complication of acute airway obstruction.JAMA1977;238,1833-1835
 
Koh, MS, Hsu, AA, Eng, P Negative pressure pulmonary oedema in the medical intensive care unit.Intensive Care Med2003;29,1601-1604
 
Devys, JM, Balleau, C, Jayr, C, et al Biting the laryngeal mask: an unusual cause of negative pressure pulmonary edema.Can J Anaesth2000;47,176-178
 
Cascade, PN, Alexander, GD, Mackie, DS Negative-pressure pulmonary edema after endotracheal intubation.Radiology1993;186,671-675
 
Dolinski, SY, MacGregor, DA, Scuderi, PE Pulmonary hemorrhage associated with negative-pressure pulmonary edema.Anesthesiology2000;93,888-890
 
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