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Negative-pressure pulmonary edema
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(Redirected from Negative-pressure pulmonary edema (NPPE))
Contents
Background
- Negative-pressure pulmonary edema (NPPE) occurs after a patient makes strong inspiratory effort against a blocked airway. The negative pressure causes hydrostatic edema that can be life-threatening if not but minimized if treated early, usually resolves after 24-48 hours. [1]
- Patients have and airway obstructive process either from an allergy, laryngospasm, trauma, and commonly in the case of hangings.[2]
Clinical Features
- Crackles
- Respiratory distress
- Increased jugular venous distension
- Signs of poor organ perfusion
Differential Diagnosis
Acute dyspnea
Emergent
- Pulmonary
- Airway obstruction
- Anaphylaxis
- Angioedema
- Aspiration
- Asthma
- Cor pulmonale
- Inhalation exposure
- Noncardiogenic pulmonary edema
- Pneumonia
- Pneumocystis Pneumonia (PCP)
- Pulmonary embolism
- Pulmonary hypertension
- Tension pneumothorax
- Idiopathic pulmonary fibrosis acute exacerbation
- Cardiac
- Other Associated with Normal/↑ Respiratory Effort
- Other Associated with ↓ Respiratory Effort
Non-Emergent
- ALS
- Ascites
- Uncorrected ASD
- Congenital heart disease
- COPD exacerbation
- Fever
- Hyperventilation
- Interstitial lung disease
- Neoplasm
- Obesity
- Panic attack
- Pleural effusion
- Polymyositis
- Porphyria
- Pregnancy
- Rib fracture
- Spontaneous pneumothorax
- Thyroid Disease
Evaluation
Management
- Remove any obstructive processes
- Intubation is often required
- Positive pressure ventilation
- Patients with severe pulmonary edema that do not respond to standard ventilator strategies may require proning or even ECMO
Disposition
- Admission for continued monitoring often if not always in the ICU
See Also
External Links
References
- ↑ Bhattacharya M, Kallet RJ, Ware LB, Matthay MA. Negative-pressure pulmonary edema. Chest. 2016;150(4):927-33.
- ↑ Contou D, Voiriot G, Djibre et al. Clinical features of patients with diffuse alveolar hemorrhage due to negative-pressure pulmonary edema. Lung. 2017;195(4):477-487.
