Department of Anesthesia and Critical Care, Erzincan Binali Yıldırım University, Erzincan, Turkey.
Department of Plastic and Reconstructive Surgery, Mengucek Gazi Training and Research Hospital, Erzincan, Turkey.
Pan Afr Med J. 2022 May 9;42:15. doi: 10.11604/pamj.2022.42.15.32010. eCollection 2022.
Negative-pressure pulmonary edema (NPPE) is a rare but life-threatening postoperative complication that occurs due to the acute obstruction of the upper airway. In our case report, we present a 25-year-old female patient who underwent elective mammoplasty under general anesthesia and developed NPPE 4 hours after extubation. The patient had a preoperative mallampati score of 3. After routine anesthesia induction, the patient was intubated with an endotracheal tube with a guide wire. Aspiration wasn't observed during extubation. The patient was followed in the post-anesthesia care unit (PACU) for 30 minutes with a saturation of 95% and was subsequently transferred to the service. Four hours after the operation, the patient was re-examined due to dyspnea and shortness of breath. Due to oxygen saturation of 88% and pOof 56mmHg despite mask ventilation, the patient was admitted to the intensive care unit (ICU). A computed tomography (CT) scan revealed extensive diffuse ground-glass opacities and consolidations in both lungs. She did not respond to mask ventilation and was given non-invasive ventilation with continuous positive airway pressure (CPAP). Forced diuresis was induced with furosemide. Tachypnea resolved within 2 hours after CPAP was initiated, the patient did not require oxygen support and COVID-19 polymerase chain reaction (PCR) testing was negative. Subsequently, the patient was discharged to the clinical ward on postoperative day 1. When considering NPPE, early diagnosis and respiratory support are associated with reduced mortality and rapid recovery. Patients who develop laryngospasm during extubation must be closely monitored, and in the case of pulmonary edema, NPPE should be considered in the differential diagnosis.
负压性肺水肿（NPPE）是一种罕见但危及生命的术后并发症，是由于上呼吸道急性阻塞引起的。在我们的病例报告中，我们介绍了一位 25 岁的女性患者，她在全身麻醉下接受了择期乳房成形术，并在拔管后 4 小时发生 NPPE。患者术前 Mallampati 评分为 3 分。在常规麻醉诱导后，患者使用带有导丝的气管内导管进行插管。拔管时未观察到抽吸。患者在麻醉后恢复室（PACU）中观察 30 分钟，饱和度为 95%，随后转至病房。术后 4 小时，患者因呼吸困难和呼吸急促再次就诊。尽管进行了面罩通气，但患者的氧饱和度为 88%，pO2 为 56mmHg，因此收入重症监护病房（ICU）。计算机断层扫描（CT）显示双肺广泛弥漫性磨玻璃影和实变。患者对面罩通气无反应，给予持续气道正压通气（CPAP）的无创通气。给予呋塞米进行强力利尿。CPAP 启动后 2 小时内呼吸急促得到缓解，患者无需吸氧支持，COVID-19 聚合酶链反应（PCR）检测为阴性。随后，患者在术后第 1 天出院至临床病房。考虑到 NPPE，早期诊断和呼吸支持与降低死亡率和快速康复相关。拔管期间发生喉痉挛的患者必须密切监测，如果发生肺水肿，应考虑 NPPE 进行鉴别诊断。
