Chest
Volume 115, Issue 4, April 1999, Pages 1194-1197
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Selected Reports
Negative Pressure Pulmonary Hemorrhage

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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.

Section snippets

Case Report

A 46-year-old muscular African-American man with a medical history significant for high myopia, glaucoma, mild mental retardation, and cocaine abuse underwent elective vitreous debridement and cataract removal for scarring due to bleb-associated endophthalmitis of his right eye. Preoperative testing was not performed. General anesthesia was induced with propofol and fentanyl and was maintained with isoflurane and nitrous oxide. The patient was given succinylcholine prior to an atraumatic

Discussion

We have presented a case of a 46-year-old man who underwent routine surgery with general anesthesia and suffered from hypoxemic respiratory failure following extubation. He likely experienced acute UAO secondary to redundant pharyngeal soft tissue and loss of muscle tone related to the postanesthetic state. Vigorous inspiratory efforts against an obstructed upper airway (the modified Mueller maneuver) led to the development of acute NPPE. Our patient, however, developed frank alveolar

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