1/3. Negative pressure pulmonary oedema in the medical intensive care unit.OBJECTIVE: Negative pressure pulmonary oedema (NPPE) occurring in the medical intensive care unit (MICU) is an uncommon, probably under-diagnosed, but life-threatening condition. DESIGN: Retrospective data collection. SETTING: Medical intensive care unit in a 1,500-bedded tertiary care hospital. patients AND PARTICIPANTS: Five patients were diagnosed between January 1998 and January 2002. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Five patients were diagnosed to have NPPE from different aetiologies. These were acute epiglottitis, post-stenting of right bronchus intermedius stenosis, strangulation, compression from a goitre and one patient developed diffuse alveolar haemorrhage after biting the endotracheal tube during recovery from anaesthesia. All patients responded rapidly to supplemental oxygen, positive pressure ventilation and correction of underlying aetiologies. Pulmonary oedema resolved rapidly. CONCLUSIONS: There is a large spectrum of aetiologies causing NPPE in the medical intensive care unit.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Stridor in an adult. An unusual presentation of functional origin.A 34-year-old woman with a recent history of a influenza-like illness and signs of bronchopneumonia presented with many of the features of acute epiglottitis, a condition which still carries a high mortality in adults. Urgent laryngoscopy and bronchoscopy under inhalational anaesthesia were negative. The results of arterial blood gases, taken when stridor was at its worst, revealed marked hypocapnia and respiratory alkalosis. We conclude that the resultant acute reduction of serum ionised calcium produced stridor as a result of tetany of the vocal cords. Similar cases from the literature and the role of emotional factors in the aetiology are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/3. pulmonary edema due to partial upper airway obstruction in a child.The case of an 8-year-old boy is reported, who developed acute pulmonary edema associated with acute subglottic swelling and subsequent partial upper airway obstruction after extubation and recovery from anaesthesia. The main factors responsible for the formation of pulmonary edema presumably are a large subatmospheric transpulmonary pressure gradient and hypoxia leading to translocation of circulating blood volume into the pulmonary vasculature and fluid shift across the alveolar-capillary membrane. Application of oxygen and CPAP or PEEP plus diuretic therapy will promote rapid clearance of the pulmonary edema.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |