Post-obstructive pulmonary oedema is a type of non-cardiogenic pulmonary oedema, and is an uncommon, but well-described, complication of upper airway obstruction.
It essentially occurs in three clinical settings 6:
- acute airway obstruction
- chronic upper airway obstruction
- immediately after the relief of acute upper airway obstruction
Two different mechanisms have been proposed for the development of pulmonary oedema in the setting of upper airway obstruction 1:
- due to significant fluid shifts due to changes in intrathoracic pressure creating a hydrostatic transpulmonary gradient with fluid moving from high pressure (pulmonary venous system) to low pressure (pulmonary interstitium and airspaces)
- disruption of the alveolar epithelial and pulmonary microvascular membranes from severe mechanical stress, leading to increased pulmonary capillary permeability and protein-rich pulmonary oedema
The most common cause of post-obstructive pulmonary oedema is laryngospasm during intubation or after anaesthesia in the post-operative period.
Treatment and prognosis
Patients in whom post-obstructive pulmonary oedema develop generally have an uncomplicated hospital course followed by rapid resolution 1.
- 1. Fremont RD, Kallet RH, Matthay MA et-al. Postobstructive pulmonary edema: a case for hydrostatic mechanisms. Chest. 2007;131 (6): 1742-6. doi:10.1378/chest.06-2934 - Free text at pubmed - Pubmed citation
- 2. Kopp KH. [Post-obstructive pulmonary edema as a complication of endotracheal tube obstruction]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2000;35 (11): 721-4. doi:10.1055/s-2000-8160 - Pubmed citation
- 3. Padley SP, Downes MO. Case report: pulmonary oedema secondary to laryngospasm following general anaesthesia. Br J Radiol. 1994;67 (799): 654-5. doi:10.1259/0007-1285-67-799-654 - Pubmed citation
- 4. Ringold S, Klein EJ, Del beccaro MA. Postobstructive pulmonary edema in children. Pediatr Emerg Care. 2004;20 (6): 391-5. Pediatr Emerg Care (link) - Pubmed citation
- 5. Guffin TN, Har-el G, Sanders A et-al. Acute postobstructive pulmonary edema. Otolaryngol Head Neck Surg. 1995;112 (2): 235-7. - Pubmed citation
- 6. Oudjhane K, Bowen A, Oh KS et-al. Pulmonary edema complicating upper airway obstruction in infants and children. Can Assoc Radiol J. 1992;43 (4): 278-82. - Pubmed citation
- 7.Bhaskar, B., & Fraser, J. F. (2011). Negative pressure pulmonary edema revisited: Pathophysiology and review of management. Saudi Journal of Anaesthesia, 5(3), 308–313. doi:10.4103/1658-354X.84108