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Contemporary Reviews in Critical Care Medicine |

Negative Pressure Pulmonary Edema

Mallar Bhattacharya, MD; Richard H. Kallet, MS, RRT; Lorraine B. Ware, MD; Michael A. Matthay, MD
Author and Funding Information

Conflict of interest statements for all authors: MAM has participated on DSMB committees for clinical trials for RocheGenentec and GlaxoSmithKline and received grant support from Amgen and GlaxoSmithKline for research studies. He has also consulted for GlaxoSmithKline, Biogen, Cerus Inc., Quark Pharmaceuticals, Global Blood Products and Amgen.

All others: declare no conflicts of interest.

Correspondence to: Michael A. Matthay MD University of California, San Francisco 505 Parnassus Avenue Moffitt Hospital, Room M-917 San Francisco, CA 94143-0624


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.03.043
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Abstract

Negative pressure pulmonary edema (NPPE) or post-obstructive pulmonary edema is a well-described cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed airway, usually from upper airway infection, tumor, or laryngospasm. Patients with NPPE generate very negative airway pressures, which augment transvascular fluid filtration and precipitate interstitial and alveolar edema. Pulmonary edema fluid collected from most patients with NPPE has a low protein concentration, suggesting hydrostatic forces as the primary mechanism for the pathogenesis of NPPE. Supportive care should be directed at relieving the upper airway obstruction with endotracheal intubation or cricothyroidotomy, institution of lung protective positive pressure ventilation, and diuresis unless the patient is in shock. Resolution of the pulmonary edema is usually rapid, in part because alveolar fluid clearance mechanisms are intact. In this review, we discuss the clinical presentation, pathophysiology, and management of negative pressure or post-obstructive pulmonary edema.


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