Abstract
Purpose
To present the first photographed bronchoscopic findings associated with negative pressure pulmonary oedema (NPPE).
Clinical features
A previously healthy patient underwent anterior C3–C4 disc removal and arthrodesis. Following tracheal extubation he developed acute respiratory distress manifested as stridor, tachypnoea, restlessness, and desaturation. Once the trachea was reintubated, he displayed the classic findings of pulmonary oedema. Bronchoscopy was performed to confirm tracheal tube position and to rule out tracheal injury secondary to surgical manipulation. Diffuse punctate haemorrhages were noted throughout the visualised tracheobronchial tree.
Conclusion
We believe that these haemorrhages represent disruption of the bronchial vasculature and may contribute to the clinical presentation of NPPE.
Résumé
Objectif
Présenter les premières photographies par bronchoscopie d’un oedème pulmonaire provoqué par une pression pulmonaire négative.
Eléments clniques
Un patient jusque là bien portant subit une résection antérieure de disque à C3–C4 avec arthrodèse. Après l’extubation de la trachée, il développe une détresse respiratoire aiguë manifestée par du stridor, de la tachypnée, de l’agitation et de la désaturation. Une fois réintubé, il révèle les signes classiques d’un oedème pulmonaire. Une bronchoscopie est réalisée pour confirmer la position du tube endotrachéal et d’éliminer la possibilité de blessure trachéale secondaire à la manipulation chirurgicale. Des hémorragies diffuses ponctiformes sont notées sur l’arbre trachéobronchique.
Conclusion
Nous croyons que ces hémorragies représentent la rupture de la vasculature bronchique et peuvent contribuer aux manifestations cliniques d’un oedème pulmonaire associé à une pression pulmonaire négative.
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Koch, S.M., Abramson, D.C., Ford, M. et al. Bronchoscopic findings in post-obstructive pulmonary oedema. Can J Anaesth 43, 73–76 (1996). https://doi.org/10.1007/BF03015962
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DOI: https://doi.org/10.1007/BF03015962