1/272. Negative-pressure pulmonary edema: a complication of shoulder arthroscopy.Negative-pressure pulmonary edema has been increasingly reported in surgical literature since 1977, yet there are no references to this condition in current orthopedic textbooks. We report a case of negative-pressure pulmonary edema occurring during arthroscopic surgery of the shoulder. The patient required reintubation for 5 days and hospitalization for 1 week. Because arthroscopic surgery is widely believed to be without complications, we want to make orthopedic surgeons aware of the possibility of negative-pressure pulmonary edema.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/272. pulmonary edema after resection of a fourth ventricle tumor: possible evidence for a medulla-mediated mechanism.A well-recognized fact is that some patients may have development of pulmonary edema in association with disorders of the central nervous system. The origin of this phenomenon, known as neurogenic pulmonary edema, is unclear but may result, in part, from select pulmonary venoconstriction modulated by autonomic outflow from the medulla oblongata. We describe a 21-year-old man who had development of pulmonary edema in association with surgical resection of a brain tumor that was close to the medulla. Other than the possibility of medullary dysfunction, which could have occurred after surgical manipulation, no other risk factor for pulmonary edema was identified. Of note, the patient's blood pressure remained normal throughout the perioperative period, and no fluid overload or primary cardiac dysfunction was evident. This case supports the theory that the medulla is an important anatomic site of origin for neurogenic pulmonary edema and that alterations in medullary function can induce pulmonary edema in humans, independent of systemic hypertension.- - - - - - - - - - ranking = 0.14285714285714keywords = pressure (Clic here for more details about this article) |
3/272. Postoperative pulmonary edema.BACKGROUND: Noncardiogenic pulmonary edema may be caused by upper airway obstruction due to laryngospasm after general anesthesia. This syndrome of "negative pressure pulmonary edema" is apparently well known among anesthesiologists but not by other medical specialists. methods: We reviewed the cases of seven patients who had acute pulmonary edema postoperatively. RESULTS: There was no evidence of fluid overload or occult cardiac disease, but upper airway obstruction was the most common etiology. Each patient responded quickly to therapy without complications. CONCLUSIONS: Of the seven patients with noncardiogenic postoperative pulmonary edema, at least three cases were associated with documented laryngospasm causing upper airway obstruction. This phenomenon has been reported infrequently in the medical literature and may be underdiagnosed. Immediate recognition and treatment of this syndrome are important. The prognosis for complete recovery is excellent.- - - - - - - - - - ranking = 0.14285714285714keywords = pressure (Clic here for more details about this article) |
4/272. Negative pressure pulmonary hemorrhage.Negative pressure pulmonary edema, a well-recognized phenomenon, is the formation of pulmonary edema following an acute upper airway obstruction (UAO). To our knowledge, diffuse alveolar hemorrhage has not been reported previously as a complication of an UAO. We describe a case of negative pressure pulmonary hemorrhage, and we propose that its etiology is stress failure, the mechanical disruption of the alveolar-capillary membrane.- - - - - - - - - - ranking = 0.85714285714286keywords = pressure (Clic here for more details about this article) |
5/272. Haemoptysis after breath-hold diving.Pulmonary oedema has been described in swimmers and self-contained underwater breathing apparatus (Scuba) divers. This study reports three cases of haemoptysis secondary to alveolar haemorrhage in breath-hold divers. Contributory factors, such as haemodynamic modifications secondary to immersion, cold exposure, exercise and exposure to an increase in ambient pressure, could explain this type of accident. Furthermore, these divers had taken aspirin, which may have aggravated the bleeding.- - - - - - - - - - ranking = 0.14285714285714keywords = pressure (Clic here for more details about this article) |
6/272. Negative pressure pulmonary oedema caused by biting and endotracheal tube occlusion--a case for oropharyngeal airways.A patient had general anaesthesia for laparoscopic surgery. She bit on and occluded her endotracheal tube during recovery from anaesthesia. Strong inspiratory efforts during airway obstruction caused negative pressure pulmonary oedema. The pulmonary oedema resolved within 24 hours. Use of an oropharyngeal airway as a bite block could have prevented this complication.- - - - - - - - - - ranking = 0.71428571428571keywords = pressure (Clic here for more details about this article) |
7/272. Neurogenic pulmonary oedema after generalized epileptic seizure.The diagnosis 'tonic clonic seizure' is frequently established by emergency physicians on scene. In patients with epilepsy mortality due to accidents, asphyxia, cardiac arrhythmias or postictal neurogenic pulmonary oedema (NPO) is twice as high as in the general population. We report a case of acute pulmonary oedema after a tonic clonic seizure. Following this event, the patient developed respiratory insufficiency and evidence of pulmonary oedema not associated with the classic aetiologies of congestive heart failure, aspiration or toxic exposure. The patient survived the incident after aggressive prehospital treatment, long-term intensive care and subsequent rehabilitation. A systematic case analysis and an introduction to the pathophysiology of NPO are presented. We recommend a positive approach to the management of NPO consisting primarily of interventions to stabilize vital functions, decrease intracranial pressure and normalize vegetative dysregulation. Emergency physicians need to consider the possibility of NPO in all cases of pulmonary oedema of unknown origin.- - - - - - - - - - ranking = 0.14285714285714keywords = pressure (Clic here for more details about this article) |
8/272. Noncardiogenic pulmonary edema as the chief manifestation of a pheochromocytoma: a case report of men 2A with pedigree analysis of the RET proto-oncogene.Pheochromocytomas are rare neoplasias of the adrenal medulla which generally present with paroxysmal or sustained hypertension. Cardiogenic pulmonary edema is a common feature of these tumors, but few cases have been described with noncardiogenic pulmonary edema. We report a pheochromocytoma with the principle manifestation of noncardiogenic pulmonary edema and characterize a genetic lesion associated with the disorder. A 30-year-old man was admitted with abdominal pain and breathlessness. x-Ray examination of the chest revealed a massive, diffuse infiltration of the left lung without cardiomegaly. No paroxysmal blood pressure fluctuations or heart failure were evident during the entire course, and the infiltrate and dyspnea resolved in three days without inotropic or diuretic agents. serum norepinephrine and epinephrine levels were elevated twenty and fifty times above normal, respectively. The patient was ultimately diagnosed with multiple endocrine neoplasia type 2a (men 2A). Mutations in the RET proto-oncogene have been described recently in patients with men 2A. mutation analysis of selected RET exonic sequences identified a germline mutation at codon 634 in exon 11 of the RET proto-oncogene. The mutation introduces a transition encoding a non-conservative substitution from TGC (Cys) to CGC (Arg) and creates a novel restriction site recognized by HhaI. We further screened for this mutation among four of the proband's relatives by HhaI restriction analysis. One asymptomatic family member was identified who subsequently elected prophylactic total thyroid removal. Histological examination of this specimen confirmed the presence of medullary thyroid carcinoma.- - - - - - - - - - ranking = 0.14285714285714keywords = pressure (Clic here for more details about this article) |
9/272. Unilateral negative pressure pulmonary edema during anesthesia with a laryngeal mask airway.PURPOSE: To present a case of unilateral pulmonary edema after upper airway obstruction. CLINICAL FEATURES: In a 21-yr-old man, anesthesia was induced with propofol and maintained with N2O/O2/isoflurane via an LMA. After being placed in the lateral position, he had an episode of upper airway obstruction while breathing spontaneously. Hypoxemia (SpO2 80-83%) refractory to the administration of oxygen (F1O2 1.0) ensued following relief of the obstruction. Chest X-ray showed edema of the dependent lung. Treatment consisted of placing the patient in the sitting position and supplemental oxygen. The situation resolved over a few hours. CONCLUSION: If airway obstruction occurs in the lateral position, development of negative pressure pulmonary edema (NPPE) in the dependent lung is favoured by hydrostatic forces and possibly the elevated resting position of the dependent hemidiaphragm.- - - - - - - - - - ranking = 0.71428571428571keywords = pressure (Clic here for more details about this article) |
10/272. Exacerbation of acute pulmonary edema during assisted mechanical ventilation using a low-tidal volume, lung-protective ventilator strategy.STUDY OBJECTIVES: To assess the magnitude of negative intrathoracic pressure development in a patient whose pulmonary edema acutely worsened immediately following the institution of a low-tidal volume (VT) strategy. DESIGN: Mechanical lung modeling of patient-ventilator interactions based on data from a case report. SETTING: Medical ICU and laboratory. PATIENT: A patient with suspected ARDS and frank pulmonary edema. INTERVENTIONS: The patient's pulmonary mechanics and spontaneous breathing pattern were measured. Samples of arterial blood and pulmonary edema fluid were obtained. MEASUREMENTS: A standard work-of-breathing lung model was used to mimic the ventilator settings, pulmonary mechanics, and spontaneous breathing pattern observed when pulmonary edema worsened. Comparison of the pulmonary edema fluid-to-plasma total protein concentration ratio was made. RESULTS: The patient's spontaneous VT demand was greater than preset. The lung model revealed simulated intrathoracic pressure changes consistent with levels believed necessary to produce pulmonary edema during obstructed breathing. A high degree of imposed circuit-resistive work was found. The pulmonary edema fluid-to-plasma total protein concentration ratio was 0.47, which suggested a hydrostatic mechanism. CONCLUSION: Ventilator adjustments that greatly increase negative intrathoracic pressure during the acute phase of ARDS may worsen pulmonary edema by increasing the transvascular pressure gradient. Therefore, whenever sedation cannot adequately suppress spontaneous breathing (and muscle relaxants are contraindicated), a low-VT strategy should be modified by using a pressure-regulated mode of ventilation, so that imposed circuit-resistive work does not contribute to the deterioration of the patient's hemodynamic and respiratory status.- - - - - - - - - - ranking = 0.71428571428571keywords = pressure (Clic here for more details about this article) |
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