A Case of Negative Pressure Pulmonary Edema Immediately after Pharyngeal Surgery

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Pulmonary edema following acute upper airway obstruction is called negative pressure pulmonary edema (NPPE). The predominant mechanism is increased negative intrathoratic pressure, although hypoxia, cardiac and neurologic factors may contribute. We encountered a case of pulmonary edema after pharyngeal surgery. A 50-year-old male with peritonsillar abscess underwent incision and drainage under general anesthesia. After extubation of the tracheal tube following successful surgical procedure, upper airway obstruction due to laryngospasm and/or edema of the pharynx ensued. The patient developed respiratory distress with vigorous inspiratory efforts. After reestablishment of the airway, pink frothy sputum flowed from his mouth and nose. Chest X-rays demonstrated bilateral diffuse alveolar infiltration. Diuretics, steroids and mechanical ventilatory support by continuous positive airway pressure were effective. The onset of NPPE is usually rapid, and without prompt recognition and intervention, the outcome can be fatal. NPPE appears more frequently in healthy male patients, particularly patients receiving head and neck surgery with or without concurrent airway obstruction. Prevention, early diagnosis, and prompt treatment facilitate an uncomplicated resolution.