Unexpected negative-pressure pulmonary edema after tracheostomy: two case reports

Area of Science:

• Pulmonary Medicine
• Critical Care Medicine
• Anesthesiology

Background:

• Negative-pressure pulmonary edema (NPPE) is typically associated with upper airway obstruction.
• NPPE is considered uncommon in patients with secured airways, such as those with a tracheostomy.

Purpose of the Study:

• To report two distinct cases of NPPE occurring after tracheostomy.
• To emphasize the importance of considering NPPE in patients with tracheostomies.

Main Methods:

• Case 1: A 69-year-old man developed NPPE due to tracheostomy tube obstruction by secretions post-prophylactic tracheotomy for glottic carcinoma.
• Case 2: An 11-year-old boy on mechanical ventilation developed NPPE secondary to patient-ventilator asynchrony attributed to sedative withdrawal syndrome, occurring the day after tracheostomy.

Main Results:

• Both cases illustrate NPPE developing despite the presence of a secured airway via tracheostomy.
• The underlying causes were mechanical obstruction by secretions and functional airway obstruction from patient-ventilator asynchrony.

Conclusions:

• NPPE should be considered in the differential diagnosis of respiratory distress, even in patients with a tracheostomy.
• These findings underscore the need for vigilance regarding potential airway complications post-tracheostomy.