Department of Geriatrics, West Middlesex University Hospital NHS Trust, West Middlesex Hospital, London SW10 9NH, UK.
Age Ageing. 2021 Feb 26;50(2):592-594. doi: 10.1093/ageing/afaa217.
An 86-year-old female presented to the Emergency Department (ED) in respiratory distress after choking on a sandwich at home. Her family had noticed that she had had difficulty during and coughing after swallowing for several months. Her initial chest x-ray showed diffuse alveolar infiltrates in both lungs and blood tests showed normal white cells and C-Reactive Protein (CRP). She was started on intravenous antibiotics for presumed aspiration pneumonia and received 15 L of oxygen. However, the infiltration had dramatically improved, both radiologically and clinically, within 24 hours. She was diagnosed with negative pressure pulmonary oedema (NPPE) type 1 and made a rapid recovery. The Speech and Language Team diagnosed an impaired swallow and advised soft or bite-sized suitable foods. We discussed the ongoing risk of aspiration and long-term feeding options with the patient's family. We agreed on a conservative plan for 'risk feeding', given her frailty and co-morbidities, and began discussions on ceilings of care. This case aims to raise awareness of NPPE so that it can be diagnosed, investigated and treated promptly. Although seen most commonly by intensivists and anaesthetists, it is relevant to those on the acute medical take and geriatricians managing patients with swallowing difficulties.
一位 86 岁女性因在家中吃三明治时噎住而呼吸困难到急诊科就诊。她的家人注意到，她在吞咽时和之后已经有几个月都出现了困难，并且还会咳嗽。她最初的胸部 X 光显示双肺弥漫性肺泡浸润，血液检查显示白细胞和 C 反应蛋白（CRP）正常。她因疑似吸入性肺炎开始接受静脉注射抗生素治疗，并接受了 15 升氧气。然而，在 24 小时内，浸润在影像学和临床上都有明显改善。她被诊断为 1 型负压性肺水肿（NPPE），并迅速康复。言语治疗师诊断为吞咽功能受损，并建议食用软质或小块状的合适食物。我们与患者家属讨论了持续的吸入风险和长期喂养方案。考虑到她的体弱和合并症，我们商定了“风险喂养”的保守计划，并开始讨论护理上限。本病例旨在提高对 NPPE 的认识，以便能够及时诊断、调查和治疗。尽管这种情况最常见于重症监护医师和麻醉师，但它也与处理吞咽困难患者的急性内科医师和老年科医生有关。
