Severe postoperative negative pressure pulmonary edema: a case report.

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Pulmonary Medicine

Background:

• Postoperative negative pressure pulmonary edema (NPPE) is a recognized complication after general anesthesia.
• Laryngospasm is a significant risk factor, though NPPE can occur in any patient.
• Typically, NPPE is benign and reversible, but severe cases requiring intensive intervention are rare.

Observation:

• A 62-year-old male developed severe acute respiratory distress syndrome (ARDS) post-adrenalectomy following laryngospasm.
• A suspected anaphylactic reaction may have contributed to the severity of the condition.
• The patient required advanced critical care interventions.

Findings:

• Treatment involved invasive airway pressure release ventilation (APRV) and prone positioning.
• The patient demonstrated a drastic improvement in respiratory function.
• Recovery led to discharge from the ICU after 10 days and the hospital after 14 days.

Implications:

• This case underscores that NPPE, while usually mild, can present with unusual severity.
• Prompt recognition and advanced critical care, including APRV and prone positioning, are crucial for managing severe NPPE.
• Anesthesiologists and critical care physicians should maintain a high index of suspicion for NPPE in patients with respiratory compromise post-anesthesia.