• Mallar Bhattacharya, Richard H Kallet, Lorraine B Ware, and Michael A Matthay.
• Departments of Medicine, Anesthesia, and Respiratory Care, University of California, San Francisco, San Francisco, CA.
• Chest. 2016 Oct 1; 150 (4): 927-933.

AbstractNegative-pressure pulmonary edema (NPPE) or postobstructive pulmonary edema is a well-described cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed airway, usually from upper airway infection, tumor, or laryngospasm. Patients with NPPE generate very negative airway pressures, which augment transvascular fluid filtration and precipitate interstitial and alveolar edema. Pulmonary edema fluid collected from most patients with NPPE has a low protein concentration, suggesting hydrostatic forces as the primary mechanism for the pathogenesis of NPPE. Supportive care should be directed at relieving the upper airway obstruction by endotracheal intubation or cricothyroidotomy, institution of lung-protective positive-pressure ventilation, and diuresis unless the patient is in shock. Resolution of the pulmonary edema is usually rapid, in part because alveolar fluid clearance mechanisms are intact. In this review, we discuss the clinical presentation, pathophysiology, and management of negative-pressure or postobstructive pulmonary edema.Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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