Negative pressure pulmonary edema (NPPE) is a rare perioperative complication with a potentially fatal outcome. The aim of this study was to perform a systematic review of NPPE in adult otolaryngology procedures with the goal of identifying risk factors, clinical presentation, diagnosis, management and outcomes.
Methods:
Systematic review performed using PubMed, Scopus, Web of Science, and Cochrane databases.
Results:
Sixty-nine studies including data from 87 individual patients were included in this review. Fifty-six (68%) patients were male and the average patient age was 37 years old. Type 1 NPPE occurred in 63 (72%) cases, while type 2 NPPE accounted for 20 (23%) cases. The most common procedures leading to NPPE were septoplasty, rhinoplasty or sinus surgery (n = 22, 25%), directly laryngoscopy or bronchoscopy (n = 13, 15%), and tracheostomy or cricothyroidotomy (n = 11, 13%). The most employed treatment options included diuretics (n = 55, 63%) and mechanical ventilation (n = 54, 62%). Seventy-eight (90%) patients made a full recovery with an average time to NPPE resolution of 33 hours and an average length of hospitalization of 5.6 days. Five (6%) patients had a long-term morbidity and four (5%) patients died, with age and ICU stay increasing risk for death and long-term morbidity (OR 1.044 and 7.42, respectively, P < .05).
Conclusion:
Septoplasty, rhinoplasty and sinus surgery account for the majority of NPPE cases in adult otolaryngology procedures. Young, healthy patients are the most commonly involved with a slight male predominance. The vast majority of patients recover fully, however there is a significant risk for morbidity and mortality.
GoldenbergJDPortugalLGWenigBLWeingartenRT.Negative-pressure pulmonary edema in the otolaryngology patient. Otolaryngol Neck Surg. 1997;117(1):62-66.
3.
WestreichRSampsonIShaariCMLawsonW.Negative-pressure pulmonary edema after routine septorhinoplasty: discussion of pathophysiology, treatment, and prevention. Arch Facial Plast Surg. 2006;8(1):8-15.
4.
OlssonGLHallenB.Laryngospasm during anaesthesia. A computer-aided incidence study in 136 929 patients. Acta Anaesthesiol Scand. 1984;28(5):567-575.
5.
TweedieDJBajajYIfeachoSN, et al. Peri-operative complications after adenotonsillectomy in a UK pediatric tertiary referral centre. Int J Pediatr Otorhinolaryngol. 2012;76(6):809-815.
6.
ThiagarajanRRLaussenPC.Negative pressure pulmonary edema in children – pathogenesis and clinical management. Pediatr Anesth. 2007;17(4):307-310.
7.
MuradMHSultanSHaffarSBazerbachiF.Methodological quality and synthesis of case series and case reports. BMJ Evid-Based Med. 2018;23(2):60-63.
8.
LeeDJYangWPropstEJRosenblattSDHseuAWolterNE. Tracheo-innominate fistula in children: A systematic review of literature: pediatric Tracheo-Innominate Fistula [published online January 10, 2019]. Laryngoscope. doi:10.1002/lary.27765
9.
AdolphMDOliverAMDejakT.Death from adult respiratory distress syndrome and multiorgan failure following acute upper airway obstruction. Ear Nose Throat J. 1994;73(5):324-327.
10.
AnsaFKanaparthiLCarinoGDhupaADaoudEYodiceP.Rapid-onset pulmonary edema after routine elective surgery: a review of two cases. Chest. 2006;130(suppl 4):343S.
11.
BachmannPGaussorguesPPignatJ-C, et al. Pulmonary edema secondary to warfarin-induced sublingual and laryngeal hematoma. Crit Care Med. 1987;15(11):1074-1075.
CascadePNAlexanderGDMackieDS.Negative-pressure pulmonary edema after endotracheal intubation. Radiology. 1993;186(3):671-675.
14.
ChoiEYiJJeonY.Negative pressure pulmonary edema after nasal fracture reduction in an obese female patient: a case report. Int Med Case Rep J. 2015;8:169-171.
15.
ChoiHLMinJHKangJHKimHParkJS.Postobstructive pulmonary edema that developed immediately after emergency surgical cricothyroidotomy. Am J Emerg Med. 2016;34(5):936.e1-936.e2.
16.
ChuangY-CWangC-HLinY-S.Negative pressure pulmonary edema: report of three cases and review of the literature. Eur Arch Otorhinolaryngol. 2007;264(9):1113-1116.
17.
DashHHCheriyanAFSinglaR.Acute fulminating pulmonary oedema following relief of airway obstruction. Indian J Chest Dis Allied Sci. 1983;25(2):145-148.
18.
DedioRMHendrixRA.Postobstructive pulmonary edema. Otolaryngol Head Neck Surg. 1989;101(6):698-700.
19.
DeSioJMBaconDR.Complete airway obstruction caused by a pseudomembranous cast with subsequent negative pressure pulmonary edema. Anesth Analg. 1993;76(5):1142-1143.
20.
DicpinigaitisPVMehtaDC.Postobstructive pulmonary edema induced by endotracheal tube occlusion. Intensive Care Med. 1995;21(12):1048-1050.
21.
DieuTUpjohnE.Negative pressure pulmonary edema in healthy cosmetic surgery patients. Aesthet Surg J. 2003;23(4):270-273.
22.
DolinskiSYMacGregorDAScuderiPE.Pulmonary hemorrhage associated with negative-pressure pulmonary edema. Anesthesiol J Am Soc Anesthesiol. 2000;93(3):888-890.
23.
FrankLPSchreiberGC.Pulmonary edema following acute upper airway obstruction. Anesthesiol J Am Soc Anesthesiol. 1986;65(1):106-106.
24.
Furuhashi-YonahaADohiSOshimaTUedaN.Acute pulmonary edema caused by impaired switching from nasal to oral breathing in the emergence from anesthesia. Anesthesiol J Am Soc Anesthesiol. 2000;92(4):1209-1209.
25.
GabbottDAGregoryM.Unilateral pulmonary oedema following laryngospasm. Anaesth Intensive Care. 1997;25(5):550-552.
26.
GoliAKGoliSAByrdRPRoyTM.Spontaneous negative pressure changes: an unusual cause of noncardiogenic pulmonary edema. J Ky Med Assoc. 2003;101(8):317-320.
27.
GuptaMAkhavanAHallMPaleseM.Negative pressure pulmonary edema after laparoscopic donor nephrectomy. JSLS. 2012;16(4):647-649.
28.
GuruPKAgarwalAPimentelMRMcLaughlinDCBansalV. Postoperative pulmonary edema conundrum: a case of negative pressure pulmonary edema. Case Rep Crit Care. 2018:1584134.
29.
HendlerBHLevinLM.Postobstructive pulmonary edema as a sequela of temporomandibular joint arthroscopy: a case report. J Oral Maxillofac Surg. 1993;51(3):315-317.
30.
HochbergES.Adult epiglottitis complicated by negative pressure pulmonary edema. J Am Acad PAs. 2014;27(6):50.
31.
HongSOChungJ-YLeeD-W.Quick and accurate measures in negative pressure pulmonary edema: a guideline for orthognathic surgeons. J Craniofac Surg. 2014;25(5):e433-e435.
32.
HsuY-WHsuS-WHuangA-L, et al. Pulmonary edema induced by upper airway obstruction–report of 3 cases. Acta Anaesthesiol Sin. 1995;33(2):123-127.
33.
HussainRMMubeenMRazaN.Negative pressure pulmonary edema - an unusual potential hazard of ENT surgery. Pak J Otolaryngol. 2008;24(2):23-24.
34.
IkedaHAsatoRChinK, et al. Negative-pressure pulmonary edema after resection of mediastinum thyroid goiter. Acta Otolaryngol. 2006;126(8):886-888.
JainAKChatterjiCGurnaniA.Noncardiogenic pulmonary edema following respiratory obstruction after tracheal extubation. J Anaesthesiol Clin Pharmacol. 1997;13:167-170.
37.
JenkinsJG.Pulmonary edema following laryngospasm. Anesthesiology. 1984;60(6):611-612.
38.
KadotaYImabayashiTGushikenTKawasakiKOdaTYoshimuraN.[Pulmonary edema due to acute airway obstruction immediately after tracheal extubation]. Masui. 1998;47(11):1333-1337.
39.
KalletRDanielBMGropperMMatthayMA.Acute pulmonary edema following upper airway obstruction: case reports and brief review. Respir Care. 1998;43(6):476-480.
40.
KayaZTuncezAGokUGulEEAltunbasG.Negative pressure pulmonary edema following septoplasty surgery triggering acute subendocardial myocardial in farction. Heart Views. 2014;15(2):46-48.
41.
KimWHRyuSA.Acute pulmonary edema secondary to upper airway obstruction by bilateral vocal cord paralysis after total thyroidectomy - a case report. Korean J Anesthesiol. 2012;62(4):387-390.
42.
LathanSRSilvermanMEThomasBLWatersWC.Postoperative pulmonary edema. South Med J. 1999;92(3):313-315.
43.
LimKA.Post-laryngospasm pulmonary oedema in oral & maxillofacial surgery. Singapore Dent J. 2000;23(suppl 1):38-41.
44.
LloydCKamisettyA.Negative pressure pulmonary edema following open reduction and internal fixation of a fractured mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95(1):2.
45.
LorchDGSahnSA.Post-extubation pulmonary edema following anesthesia induced by upper airway obstruction: are certain patients at increased risk?Chest. 1986;90(6):802-805.
46.
MamiyaHIchinoheTKanekoY.Negative pressure pulmonary edema after oral and maxillofacial surgery. Anesth Prog. 2009;56(2):49-52.
MaroofMKhanRMRyleyBGBariNCooperT.Post-anaesthetic pulmonary oedema following upper airway obstruction. JPMA J Pak Med Assoc. 1994;44(10):244-247.
49.
McConkeyPP.Postobstructive pulmonary oedema–a case series and review. Anaesth Intensive Care. 2000;28(1):72-76.
50.
McShaneRH.Letters to the Editor. J Trauma Acute Care Surg. 1997;43(1):174.
51.
MehtaVMHar-ElGGoldsteinNA.Postobstructive pulmonary edema after laryngospasm in the otolaryngology patient. Laryngoscope. 2006;116(9):1693-1696.
52.
MelnickBM.Postlaryngospasm pulmonary edema in adults. Anesthesiology. 1984;60(5):516-517.
53.
MiroAMShivaramUFinchPJ.Noncardiogenic pulmonary edema following laser therapy of a tracheal neoplasm. Chest. 1989;96(6):1430-1431.
54.
MussiRKToroIFC. Edema e hemorragia pulmonar por pressão negativa associados à obstrução das vias aéreas superiores. J Bras Pneumol. 2008;34(6):420-424.
55.
OlsenKS.Naloxone administration and laryngospasm followed by pulmonary edema. Intensive Care Med. 1990;16(5):340-341.
56.
OswaltCEGatesGAHolmstromMG.Pulmonary edema as a complication of acute airway obstruction. JAMA. 1977;238(17):1833-1835.
57.
PriceSLHeckerBR.Pulmonary oedema following airway obstruction in a patient with Hodgkin’s disease. Br J Anaesth. 1987;59(4):518-521.
ScarbroughFEWittenbergJMSmithBRAdcockDK.Pulmonary edema following postoperative laryngospasm: case reports and review of the literature. Anesth Prog. 1997;44(3):110-116.
62.
SharmaSJainA. Negative- pressure pulmonary oedema after septoplasty. Internet J Anesthesiol. http://ispub.com/IJA/17/1/7052. Accessed October 16, 2019.
63.
SharmaMLBeckettNGormleyP.Negative pressure pulmonary edema following thyroidectomy. Can J Anesth. 2002;49(2):215.
64.
SharmaRRamachandranTRNavneethakrishnanSVeliathDGRaniPKumarAM.Negative pressure pulmonary edema after routine elective surgery- a review of two cases. J Anaesthesiol Clin Pharmacol. 2008;24(2):231.
65.
SharmaSSamplayMVarshnayS. Pulmonary edema after thyroidectomy: case report and review. Internet J Anesthesiol. http://ispub.com/IJA/18/2/3357. Accessed October 16, 2019
66.
SiddiquiRKhaliqueKKhanMAAminMU.Pulmonary edema and lung injury after severe laryngospasm. J Coll Physicians Surg–Pak JCPSP. 2006;16(12):777-779.
67.
SiddiqueMHaqIHaqA.Case report – Bilateral lung collapse due to aspirated nasal packing. Anaesth Pain Intensive Care. 2009;13(2):75-77.
68.
SinghPPDimichIShamsiA.Intraoperative pulmonary oedema in a young cocaine smoker. Can J Anaesth. 1994;41(10):961-964.
69.
SoldanoSLPlaceLBEdwardsFHCohenAJ.Post-extubation non-cardiogenic pulmonary edema. Mil Med. 1993;158(4):278-280.
70.
TamiTAChuFWildesTOKaplanM.Pulmonary edema and acute upper airway obstruction. The Laryngoscope. 1986;96(5):506-509.
71.
WadhwaRKalraS.Negative pressure pulmonary oedema after rhinoplasty. Indian J Anaesth. 2010;54(4):363-364.
72.
WilsonGWBircherNG.Acute pulmonary edema developing after laryngospasm: report of a case. J Oral Maxillofac Surg. 1995;53(2):211-214.
73.
WuM-FLiY-SHungC-Y, et al. Relapsing polychondritis with initial presentations of recurrent negative-pressure pulmonary edema and acute respiratory failure. Respir Care. 2015;60(5):e101-e104.
74.
LemyzeMMallatJ.Understanding negative pressure pulmonary edema. Intensive Care Med. 2014;40(8):1140-1143.
75.
VisvanathanTKlugerMWebbRWesthorpeR.Crisis management during anaesthesia: laryngospasm. Qual Saf Health Care. 2005;14(3):e3.
76.
IkariTSasakiCT.Glottic closure reflex: control mechanisms. Ann Otol Rhinol Laryngol. 1980;89(3Pt 1):220-224.
77.
GavelGWalkerRW.Laryngospasm in anaesthesia. Contin Educ Anaesth Crit Care Pain. 2014;14(2):47-51.
78.
KoçCKocamanFAygençEOzdemCCekiçA.The use of preoperative lidocaine to prevent stridor and laryngospasm after tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg. 1998;118(6):880-882.
79.
QiXLaiZLiSLiuXWangZTanW.The efficacy of lidocaine in laryngospasm prevention in pediatric surgery: a network meta-analysis. Sci Rep. 2016;6:32308.
80.
LynetteMJHillelATHerzerKRAkstSAMichelsonJD. General considerations of anesthesia and management of the difficult airway. In: FlintPWHaugheyBHLundVNiparkoJKRobbinsKTThomasJRLesperanceMM (eds). Cummings Otolaryngology. Vol 1. 6th ed.Saunders; 2015:82.
81.
SonsuwanNPornlertASawanyawisuthK.Risk factors for acute pulmonary edema after adenotonsillectomy in children. Auris Nasus Larynx. 2014;41(4):373-375.
82.
PattonWCBakerCL.Prevalence of negative-pressure pulmonary edema at an orthopaedic hospital. J South Orthop Assoc. 2000;9(4):248-253.
83.
MatsuuraYNomimuraTMurakamiHMatsushimaTKakehashiMKajiharaH.Clinical analysis of reexpansion pulmonary edema. Chest. 1991;100(6):1562-1566.
84.
BhaskarBFraserJF.Negative pressure pulmonary edema revisited: pathophysiology and review of management. Saudi J Anaesth. 2011;5(3):308-313.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
