Epiglottitis and pulmonary oedema in children

Abstract

We have presented three patients with epiglottitis who developed pulmonary oedema during the course of treatment with nasotracheal intubation and antibiotics. The exact mechanism for the development of pulmonary oedema in these patients is not known. Possible mechnisms are changed in the physical factors controlling the movement of fluids across the capillary-alveolar membrane, transitory bacteraemia and endotoxinaemia, or myocardial depression by the antibiotics and the anaesthetic agent. The pulmonary oedema had a benign course and responded to mechanical ventilation and increased airway pressure.

Postobstructive Pulmonary Edema in Children

“…3 The first pediatric case reports describing POPE in association with acute upper airway obstruction were published in the 1970s and described pulmonary edema following foreign body aspiration and following the relief of airway obstruction resulting from croup and epiglottitis. [4][5][6] The first case series in adults was published in 1977 and described pulmonary edema in association with laryngeal tumor, strangulation, and interrupted hanging. 7 Additional case series and reports have subsequently described pulmonary edema as a relatively rare complication of acute and chronic upper airway obstruction from a multitude of causes.…”

“…The reported incidences in these series range from 2.9% to 9.6% overall, with an incidence of 12% to 28% in patients with upper airway obstruction severe enough to require intubation. 6,8,9 A summary of 45 pediatric cases of type I POPE in the literature before 1990 reported a maleto-female ratio of 2.4:1. The time to onset of edema in this series ranged from 5 to 240 minutes following the onset of obstruction, with a mean of 33 minutes.…”

Pulmonary oedema following choking: report of two cases

“…PE complicating other forms of acute U A O was documented, however, by several authors in children suffering from croup and epiglottitis [8,11]. The cause of PE in acute U A O is as yet unclear.…”

“…The cause of PE in acute U A O is as yet unclear. Based on observations in experimental animals and humans Travis et al [11] and Soliman and Richer [8] postulated that hypoxia during the obstruction produces increased capillary permeability and pulmonary vasoconstriction [6]. Hypoxia also produces a massive sympathetic dis-…”

“…It has also been reported in croup and epiglottitis [8,11]. On the other hand, PE following short episodes of choking on food is extremely rare, being reported only once before [1].…”