Post-obstructive pulmonary oedema is 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 postobstructive 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 the rapid resolution 1.
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