Abstract
We report the case of a healthy one-month-old male infant who underwent an uneventful endotracheal anaesthetic for hernia repair. During transport to the recovery room (a < 30 second trip), the endotracheal tube in the spontaneously breathing infant became obstructed, possibly due to impaction of the tip in the right main bronchus. Restoration of the airway was followed by fulminant pulmonary oedema. Several days of vigorous respiratory and pharmacologic therapy were required for resolution of the infant’s respiratory distress. We review other reported cases of acute airway obstruction associated with pulmonary oedema in children and briefly describe the proposed mechanisms. The difficulties of gauging proper endotracheal tube depth in the infantare noted. This case report demonstrates the importance of continuous monitoring during patient transport to the recovery room.
Résumé
On rapporte le cas ďun enfant mâle âgé ďun mois en bonne santé ayant subi une herniorraphie sous anesthésie générale par voie endotrachéale. Durant le transport à la salle de réveil (un transport < à 30 secondes), le tube endotrachéal fut obstrué alors que ľenfant était en respiration spontanée possiblement après enfoncement du bout du tube endotrachéal dans la bronche souche droite. La correction de la situation fut suivie par un oedème pulmonaire fulminant. Plusieurs jours de traitement respiratoire et pharmacologique ont été requis afin de corriger la détresse respiratoire de ľenfant. On revoit les histoires de cas ďune obstruction aiguë des voies aériennes associée avec ľoedème pulmonaire chez les enfants et on décrit brièvement les mécanismes proposés. Les difficultés de juger ta profondeur appropriée du tube endotrachéal chez ľenfant sont notées. Cette histoire de cas démontre ľimportance ďune surveillance continue lors du transport du patient en salle de réveil.
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References
Lee KWT, Dowes JJ. Pumonary edema secondary to laryngospasm in children. Anesthesiology 1983; 59: 347–9.
Barin ES, Stevenson IF, Donnelly GL, Pulmonary oedema following acute upper airway obstruction. Anaesth Intensive Care 1986; 14: 54–7.
Sofer S, Bar-Ziv J, Mogle P. Pulmonary oedema following choking: report of two cases. Eur J Pediatr 1985; 143: 295–6.
Roa NL, Moss KS. Treacher-Collins syndrome with sleep apnea: anesthetic considerations. Anesthesiology 1984; 60: 71–3.
Kanter RK, Watchko JF. Pulmonary edema associated with upper airway obstruction. Am J Dis Child 1984; 138: 356–8.
Sofer S, Bar-Ziv J, Scharf SM, Pulmonary edema following relief of upper airway obstruction. Chest 1984; 86: 401–3.
deSoto H, Johnston JF. Pulmonary edema caused by endotracheal tube occlusion: a preventable mishap. Anesthesiol Rev 1987; 14 (July): 39–40.
Cook DR, Westman HR, Rosenfeld L, Hendershot RJ. Pulmonary edema in infants: possible association with intramuscular succinylcholine. Anesth Analg 1981; 60: 220–3.
Brown JrRE. Negative pressure pulmonary edema.In: Berry FA, (Ed). Anesthetic management of difficult and routine pediatric patients. New York: Churchill Livingstone, 1986; 169–78.
Murphy K, Tamlanovich MC. Unilateral pulmonary edema after drainage of a spontaneous pneumothorax: case report and review of the world literature. J Emerg Med 1983; 1: 29–36.
Loyd JE, Nolop KB, Parker RE, Roselli RJ, Brigham KL. Effects of inspiratory resistance loading on lung fluid balance in awake sheep. J Appl Physiol 1986; 60: 198–203.
Fishman AP. Pulmonary edema.In: Fishman AP (Ed). Pulmonary diseases and disorders. New York: McGraw Hill, 1980; 733–53.
Staub NC. The pathogenesis of pulmonary edema. Prog Cardiovasc Dis 1980; 23: 53–80.
Robotham JL, Scharf SM. Effects of positive and negative pressure ventilation on cardiac performance. Clin Chest Med 1983; 4: 161–87.
Fishman AP. Hypoxia and the pulmonary circulation. Circ Res 1976; 38: 221–31.
Malik AB, Selig WM, Burhop KE. Cellular and humoral mediators of pulmonary edema. Lung 1985; 163: 193–219.
Snapper JR. Lung mechanics in pulmonary edema. Clin Chest Med 1985; 6: 393–412.
Kuhns LR, Poznanski AK. Endotracheal tube position in the infant. J Pediatr 1971; 78: 991–6.
Bednarek FJ, Kuhns LR. Endotracheal tube placement in infants determined by suprasternal palpation: a new technique. Pediatrics 1975; 56: 224–9.
Loew A, Thibeault DW. A new and safe method to control the depth of endotracheal intubation in neonates. Pediatrics 1974; 54: 506–8.
Tochen ML, Orotracheal intubation in the newborn infant: a method for determining depth of tube insertion. J Pediatr 1979; 95: 1050–1.
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Warner, L.O., Beach, T.P. & Martino, J.D. Negative pressure pulmonary oedema secondary to airway obstruction in an intubated infant. Can J Anaesth 35, 507–510 (1988). https://doi.org/10.1007/BF03026901
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DOI: https://doi.org/10.1007/BF03026901