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Negative Pressure Pulmonary Edema Following BronchospasmNegative Pressure Pulmonary Edema and Bronchospasm

David J. Krodel, MD; Edward A. Bittner, MD, PhD, FCCP; Raja-Elie E. Abdulnour, MD; Robert H. Brown, MD, MPH; Matthias Eikermann, MD, PhD
Author and Funding Information

From the Department of Anesthesia, Critical Care, and Pain Medicine (Drs Krodel, Bittner, and Eikermann) and the Pulmonary and Critical Care Unit, Department of Medicine (Dr Abdulnour), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Department of Anesthesiology and Critical Care Medicine (Dr Brown); the Department of Environmental Health Sciences, Division of Physiology (Dr Brown); the Department of Medicine, Division of Pulmonary Medicine (Dr Brown); and the Department of Radiology (Dr Brown), Johns Hopkins University, Baltimore, MD.

Correspondence to: David J. Krodel, MD, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; e-mail: dkrodel@partners.org


Funding/Support: This work was supported entirely by departmental and/or institutional resources.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(5):1351-1354. doi:10.1378/chest.11-0529
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Negative pressure pulmonary edema (NPPE) is an important cause of noncardiogenic pulmonary edema but is rarely reported in the setting of bronchospasm. A 43-year-old woman with severe reactive airway disease suffered an episode of severe bronchospasm after endotracheal extubation following an otherwise uneventful general anesthetic. Subsequently, she developed clinical and radiographic signs of pulmonary edema in the absence of other symptoms of acute left-sided heart failure, leading to the diagnosis of noncardiogenic pulmonary edema. She received noninvasive positive pressure ventilation for a few hours, after which her clinical and radiologic signs and symptoms of pulmonary edema were greatly improved. This clinical scenario strongly suggests NPPE. We submit that it is possible to create NPPE by generating highly negative intrathoracic pressures in the setting of severe bronchospasm.

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