Saturday October 18, 2008

Scenario: 37 year old otherwise healthy male brought to ER with acute upper airway obstruction after developing severe angioedema secondary to seafood. In view of compromised airway, emergent intubation was performed. Despite securing airway, patient oxygen saturation remained low and required significant support of PEEP and FiO2 on mechanical ventilator. Patient's JVP is noticed to be elevated with bilateral crackles on lung auscultation. CXR showed pulmonary edema. Your probable diagnosis....



Answer: Postobstructive pulmonary edema (POPE)

POPE is the sudden onset of pulmonary edema following upper airway obstruction. There are two recognized types of POPE.

Type 1 POPE: follows a sudden, severe episode of upper airway obstruction such as postextubation laryngospasm, epiglottitis, croup, and choking.

Type II POPE: develops after surgical relief of chronic upper airway obstruction like tonsillectomy and removal of upper airway tumors.



References:

Guffin TN, Har-el G, Sanders A, Lucente FE, Nash M. Acute postobstructive pulmonary edema. Otolaryngol Head Neck Surg 1995;112:235-7.

Lang SA, Duncan PG, Shephard DA, Ha HC. Pulmonary oedema associated with airway obstruction. Can J Anaesth 1990;37:210-8.

Oswalt CE, Gates GA, Holmstrom FM. Pulmonary edema as a complication of acute airway obstruction. Rev Surg 1977;34:364-7.

Galvis AG. Pulmonary edema complicating relief of upper airway obstruction. Am J Emerg Med 1987; 5:294-7.

Scarbrough FE, Wittenberg JM, Smith BR, Adcock DK. Pulmonary edema following postoperative laryngospasm: case reports and review of the literature. Anesth Prog 1997;44:110-6.

Dicpinigaitis PV, Mehta DC. Postobstructive pulmonary edema induced by endotracheal tube occlusion. Intensive Care Med 1995;21:1048-50.