Negative pressure pulmonary edema related with severe sleep apnea syndrome: A case report

Abstract

Negative pressure pulmonary edema (NPPE) caused by airway obstruction was often life-threatening. Major cause of NPPE in adult patients was reported as post-operative laryngospasm. Therefore, NPPE was recognized widely among surgeons and anesthesiologist, but physicians also could face NPPE case in several clinical situation. NPPE in this case was caused by sleep apnea syndrome (SAS) as relatively rare cause. A 65-year-old female presented to emergency department due to disturbance of consciousness during sleep. This patient had desaturation requiring oxygen administration. Computed tomography showed pulmonary edema in bilateral lung fields. Comprehensive examination had no evident organic airway obstruction, and echocardiography showed normal cardiac function. This patient had been diagnosed with severe SAS with the apnea hypopnea index of 32 times/h. Therefore, we thought that the NPPE could be caused by severe SAS in this case. Continuous positive airway pressure therapy could improve this patient's symptoms promptly, and this patient could discharge without a complication. We should consider SAS as a cause of NPPE when examining NPPE patients especially with onset during sleep.

Negative pressure pulmonary edema after orotracheal extubation in emergency surgery

“…Risk factors for the development of negative pressure pulmonary edema are patients with airway injuries, upper airway surgery, obesity, obstructive sleep apnea, heart disease, orotracheal intubation, active smoking and emergency surgery (FREMONT RD, et al, 2007;TSAI PH, et al, 2018;WATANABE Y, et al, 2020). Studies also confirm the higher incidence of this complication among men (about 80%) after suffering laryngospasm after extubation and in patients classified as ASA I or II (73% of cases), again relating this complication to the high intrathoracic negative pressures produced by adult men healthy (BHATTACHARYA M, et al, 2016).…”

Negative pressure pulmonary edema (Review)

“…Chronic airway obstruction. Chronic upper airway obstruction is a prevalent condition observed in patients with various underlying factors, including obesity, obstructive sleep apnea, tonsil or gland hypertrophy, upper airway tumor, mediastinal tumor, nasopharyngeal mass, goiter and acromegaly (1,(31)(32)(33)(34). In particular, adult patients with obesity and obstructive sleep apnea, characterized by episodes of hypopnea and hypoxemia, have demonstrated a propensity for intermittent pulmonary edema stemming from recurrent upper airway obstruction (3).…”