Post-laryngospasm pulmonary edema. A case report

Abstract

Negative Pressure Pulmonary Edema (NPPE) is a potentially fatal form of non-cardiogenic pulmonary edema that generally affects young individuals without comorbidities. The pathophysiology involves the development of negative intrathoracic pressure due to intense inspiratory effort and upper airway obstruction. In adults, the most common etiology is post-extubation laryngospasm in the
immediate postoperative period, affecting less than 0.1% of healthy patients undergoing general anesthesia. We present the case of a 22-year-old male patient with no comorbidities who was admitted to the emergency department with abdominal pain. Acute appendicitis was diagnosed, and an open appendectomy was performed without complications. The patient was extubated
50 minutes after the start of surgery. Two hours later, he developed laryngospasm, with oxygen saturation levels of 88–90% without dyspnea. Despite an increase in oxygen flow, hypoxemia persisted, and a chest X-ray revealed multiple ground-glass opacities, suggesting pulmonary
edema. The patient was treated with furosemide and respiratory therapy. This reported case highlights the need to suspect a diagnosis of NPPE in young, healthy patients who develop acute hypoxemia in the immediate postoperative period, as this condition can be fatal if not promptly identified and treated.