Post-obstructive pulmonary edema is a type of non-cardiogenic pulmonary edema 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 edema in the setting of upper airway obstruction 1:
- 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 edema
The most common cause of post-obstructive pulmonary edema is laryngospasm during intubation or after anesthesia in the post-operative period.
Treatment and prognosis
Patients in whom post-obstructive pulmonary edema develops generally have an uncomplicated hospital course followed by rapid resolution 1.
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