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Canadian Journal of Anaesthesia

, Volume 37, Issue 2, pp 210–218 | Cite as

Pulmonary oedema associated with airway obstruction

  • Scott A. Lang
  • Peter G. Duncan
  • David A. E. Shephard
  • Hung C. Ha
Review Articles

Abstract

The purpose of this review is to describe the pathogenesis of pulmonary oedema associated with upper airway obstruction, summarize what is known of its clinical presentation, and reflect upon its implications for the clinical management of airway obstruction. The pathogenesis of pulmonary oedema associated with upper airway obstruction is multifactorial. However, as the phrase “negative pressure pulmonary oedema” suggests, markedly negative intrapleural pressure is the dominant pathophysiological mechanism involved in the genesis of pulmonary oedema associated with upper airway obstruction. The frequency of the event is impossible to ascertain from the literature but paediatric cases requiring airway intervention for croup or epiglottitis and adults requiring airway intervention for emergence laryngospasm or upper airway tumours account for over 50 per cent of the documented cases in each age group, respectively. Individuals at risk should be observed closely while they remain at risk. The majority of cases present within minutes either of the development of acute severe upper airway obstruction or of relief of the obstruction. Resolution is typically rapid, over a period of a few hours. Rarely is anything more required for management than the maintenance of a patent airway, supplemental oxygen, and, in approximately 50 per cent of cases, mechanical ventilation and positive end-expiratory pressure.

Key words

airway: obstruction complications: oedema, pulmonary larynx: spasm lung: oedema 

Résumé

Dans cet article, nous décrivons la pathogénése de l’oedème pulmonaire associé à l’obstruction de la partie supérieure des voies respiratoires. Nous en revoyons les aspects cliniques et, en analysons l’importance sur l’attitude à prendre devant une obstruction des voies aériennes. Les mécanismes sous-jacentes à ce type d’oedème pulmonaire sont multiples, le principal demeurant toutefois la présence de pressions intrapleurales « très » négatives. L’incidence du phénomène demeure difficile à évaluer mais il semble bien que chez les enfants, près de 50 pour cent des épisodes se produisent dans des cas de laryngite ou d’épiglottite nécessitant une intubation tandis que chez les adultes, on en retrouve une proportion semblable associée aux laryngospasmes survenant à l’émergence de l’anesthésie ou dans les cas de tumeurs situées haut dans les voies aériennes. Une fois identifiées, les victimes potentielles devraient être observées de près tant que le risque persiste même si ce sont les premières minutes qui suivent le développement ou la résolution d’une obstruction aiguë qui sont les plus critiques. Ce type d’œdème pulmonaire est transitoire, s’estompant en quelques heures. S’il survient, on doit s’assurer de la perméabilité des voies aériennes et faire respirer de l’oxygène quoique dans près de la moitié des cas, la ventilation mécanique avec pression positive en fin d’expiration s’avérera nécessaire.

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Copyright information

© Canadian Anesthesiologists 1990

Authors and Affiliations

  • Scott A. Lang
    • 1
  • Peter G. Duncan
    • 1
  • David A. E. Shephard
    • 1
  • Hung C. Ha
    • 1
  1. 1.Department of AnaesthesiaUniversity HospitalSaskatoon

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