Edema agudo pulmonar associado à obstrução das vias aéreas: relato de caso

Flora Margarida Barra Bisinotto; Ricardo de Paula Cardoso; Tânia Mara Vilela Abud

doi:10.1590/S0034-70942008000200009

Clinical Information

Edema agudo pulmonar associado à obstrução das vias aéreas: relato de caso

Acute pulmonary edema associated with obstruction of the airways: case report

Flora Margarida Barra Bisinotto; Ricardo de Paula Cardoso; Tânia Mara Vilela Abud

http://dx.doi.org/10.1590/S0034-70942008000200009 Braz J Anesthesiol, vol.58, n2, p.165-171, 2008

PDF

Downloads: 2

Resumo

JUSTIFICATIVA E OBJETIVOS: O edema pulmonar por pressão negativa tem sido definido como edema não-cardiogênico, com transudação de líquido para o interstício pulmonar, por aumento na pressão negativa intratorácica, ocasionado pela obstrução das vias aéreas superiores. Descreveu-se o caso de paciente hígida, submetida à anestesia geral, que apresentou edema agudo pulmonar após a extubação traqueal. RELATO DO CASO: Paciente de 23 anos, sexo feminino, estado físico ASA II, submetida à anestesia geral para videolaparoscopia ginecológica. O procedimento durou 3 horas, sem intercorrências. Após a extubação, a paciente apresentou laringoespasmo e diminuição da saturação de oxigênio. Houve melhora após colocação de cânula oral e administração de oxigênio, sob pressão positiva, com máscara facial. Estabilizado o quadro, foi encaminhada à sala de recuperação pós-anestésica, onde, logo após a admissão, apresentou edema agudo de pulmão com eliminação de secreção serossanguinolenta. O tratamento constou de elevação do dorso, oxigênio sob máscara, furosemida e restrição hídrica. A radiografia torácica mostrou imagem compatível com edema agudo pulmonar e área cardíaca normal. O eletrocardiograma (ECG), ecocardiografia e enzimas cardíacas estavam normais. A paciente apresentou boa evolução, recebendo alta hospitalar no dia seguinte, assintomática. CONCLUSÕES: O edema agudo de pulmão associado à obstrução das vias aéreas superiores é condição clínica que pode agravar procedimentos cirúrgicos de baixa morbidade e que aparece sobretudo em pacientes jovens. O tratamento deve ser instituído precocemente, pois a resolução também é rápida e, na maioria das vezes, sem seqüelas.

Palavras-chave

COMPLICAÇÕES, VIAS AÉREAS, obstrução

Abstract

BAKGROUND AND OBJECTIVES: Negative pressure pulmonary edema has been defined as non-cardiogenic edema, with transudation of fluid to the interstitial space of the lungs due to an increase in negative intrathoracic pressure secondary to obstruction of the upper airways. This is the case of a healthy patient who underwent general anesthesia and developed acute pulmonary edema after extubation. CASE REPORT: A 23-year old female patient, physical status ASA II, underwent gynecologic videolaparoscopy under general anesthesia. The procedure lasted 3 hours without intercurrence. After extubation the patient developed laryngeal spasm and reduction in oxygen saturation. The patient improved after placement of an oral cannula and administration of oxygen under positive pressure with a face mask. Once the patient was stable she was transferred to the recovery room where, shortly after her arrival, she developed acute pulmonary edema with elimination of bloody serous secretion. Treatment consisted of elevation of the head, administration of oxygen via a face mask, furosemide and fluid restriction. Chest X-ray was compatible with acute pulmonary edema and normal cardiac area. Electrocardiogram (ECG), echocardiogram and cardiac enzymes were normal. The condition of the patient improved and she was discharged from the hospital the following day, asymptomatic. CONCLUSIONS: Acute pulmonary edema associated with obstruction of the upper airways can aggravate surgical procedures with low morbidity, affecting mainly young patients. Early treatment should be instituted because it has a fast evolution and, in most cases, resolves without lasting damages.

Keywords

AIRWAYS, obstruction, COMPLICATIONS

Referências

Lang AS, Duncan PG, Shephard DA. Pulmonary edema associated with airway obstruction. Can J Anesth. 1990;37:116-120.

Van Kooy MA, Gargiulo RF. Postobstructive pulmonary edema. Am Fam Physician. 2000;62:401-404.

Gluecker T, Capasso P, Schnyder P. Clinical and radiologic features of pulmonary edema. Radiographics. 1999;19:1507-1531.

Bisinotto FMB, Pedrini Jr M, Alves AAR. Implantação do serviço de avaliação pré-anestésica em hospital universitário: Dificuldades e resultados. Rev Bras Anestesiol. 2007;57:167-176.

Westreich R, Sampson I, Shaari C. Negative-pressure pulmonary edema after routine septorhinoplasty. Arch Facial Plast Surg. 2006;8:8-15.

Visvanathan T, Kluger MT, Webb RK. Crisis management during anaesthesia: laryngospasm. Qual Saf Health Care. 2005;14:e3.

Schwartz DR, Maroo A, Malhotra A. Negative pressure pulmonary hemorrhage. Chest. 1999;115:1194-1197.

Tami TA, Chu F, Wildes TO. Pulmonary edema and acute upper airway obstruction. Laryngoscope. 1986;96:506-509.

Sow NY, Garewal D. Pulmonary hemorrhage in association with negative pressure edema in a intubated patient. Acta Anaesthesiol Scand. 2001;45:911-913.

Devys JM, Balleau C, Jayr C. Biting the laryngeal mask: an unusual cause of negative pressure pulmonary edema. Can J Anaesth. 2000;47:176-178.

Walker RW, Colovic V, Robinson DN. Postobstructive pulmonary oedema during anaesthesia in children with mucopolysaccharidoses. Paediatr Anaesth. 2003;13:441-447.

Timby J, Reed C, Zeilender S. "Mechanical" causes of pulmonary edema. Chest. 1990;98:973-979.

West JB, Tsukimoto K, Mathieu-Costello O. Stress failure in pulmonary capillaries. J Appl Physiol. 1991;70:1731-1742.

Dolinski SY, MacGregor DA, Scuderi PE. Pulmonary hemorrhage associated with negative-pressure pulmonary edema. Anesthesiology. 2000;93:888990.

Gupta S, Richardson J, Pugh M. Negative pressure pulmonary oedema after cryotherapy for tracheal obstruction. Eur J Anaesthesiol. 2001;18:189-191.

Gerancher JC, Weeks DB. Nasal BiPAP treats hypoxia from postobstructive pulmonary edema. Anesth Analg. 1995;80:429-430.

Taha S, Bartelmaos T, Kassas C. Complicated negative pressure pulmonary oedema in a child with cerebral palsy. Paediatr Anaesth. 2000;12:181-186.

Samet AF, Samet JP, Hirchi H. Postobstructif pulmonary oedema after endotracheal extubation at the recovery of general anaesthesia. Ann Fr Anesth Réanim. 2005;24:287-290.

Blum RH, McGowan Jr FX. Chronic upper airway obstruction and cardiac dysfunction: anatomy, pathophysiology and anesthestic implications. Pediatr Anesth. 2004;14:75-83.

Mehta VM, Gady HE, Nira AG. Postobstructive pulmonary edema after laryngospasm in the otolaryngology patient. Laryngoscope. 2006;116:1693-1696.

DeSio JM, Bacon DR. Complete airway obstruction caused by a pseudomembranous cast with subsequent negative pressure pulmonary edema. Anesth Analg. 1993;76:1142-1143.

Tarrac SE. Negative pressure pulmonary edema: a postanesthesia emergency. J Perianesth Nurs. 2003;18:317-323.

Patel AR, Bersten AD. Pulmonary haemorrhage associated with negative-pressure pulmonary oedema: a case report. Crit Care Resusc. 2006;8:115-116.

Marini JJ. Positive end-expiratory pressure in severe airflow obstruction: more than a "one-trick pont"?. Crit Care Med. 2005;33:1652-1653.

Edema agudo pulmonar associado à obstrução das vias aéreas: relato de caso

Acute pulmonary edema associated with obstruction of the airways: case report

Flora Margarida Barra Bisinotto; Ricardo de Paula Cardoso; Tânia Mara Vilela Abud

Resumo

Palavras-chave

Abstract

Keywords

Referências

Links

Compartilhar

Braz J Anesthesiol