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Vol. 15. Issue 3.
Pages 537-541 (May - June 2009)
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Vol. 15. Issue 3.
Pages 537-541 (May - June 2009)
Caso Clínico/Case Report
Open Access
Edema agudo do pulmão pós-extubação traqueal – Caso clínico
Post-tracheal extubation pulmonary oedema – Case report
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Maria de Lurdes Castro1, Petra Chaves1, Margarida Canas1, Maria Leonor Moedas2
1 Interna de Anestesiologia, Hospital de S. António dos Capuchos, Centro Hospitalar de Lisboa Central – EPE (CHLC – EPE)
2 Assistente Graduada de Anestesiologia, Hospital de S. José, CHLC – EPE
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Resumo

O edema agudo do pulmão pós-extubação traqueal é um acontecimento raro (≈ 0,1%)1. A etiologia é multifactorial, sendo a obstrução da via aérea superior o factor desencadeante principal. O esforço inspiratório contra a glote encerrada causa pressões intratorácicas muito negativas, que se transmitem ao interstício pul-monar, condicionando uma transudação de fluidos a partir dos vasos capilares pulmonares1−5. Relatamos um caso de edema agudo do pulmão pós-extubação num doente de quinze anos, operado no serviço de urgência por amputação traumática da perna esquer-da. Revemos a fisiopatologia, o padrão radiológico, potenciais factores de risco e medidas preventivas des-ta complicação respiratória pós-anestésica.

Rev Port Pneumol 2009; XV (3): 537-541

Palavras-chave:
Edema agudo do pulmão pós-extubação traqueal
obstrução da via aérea superior
laringospasmo
pressão negativa intratorácica
Abstract

Negative pressure pulmonary oedema is an uncommon complication of traqueal extubation (≈ 0,1%) mostly caused by acute upper airway obstruction. Upper airway obstruction from glottis closure leads to marked inspiratory effort, which generates negative intrathoracic pressure transmitting to pulmonary interstitium, and inducing fluid transudation from pulmonary capillary bed1−5. We report a case of post-extubation pulmonary oedema in a fifteen years old patient, submitted to surgery following traumatic amputation of his left leg. We review the pathophysiology, radiological findings, potential risk factors and preventive measures of this post-anaesthetic respiratory complication.

Rev Port Pneumol 2009; XV (3): 537-541

Key-words:
Post-extubation pulmonary oedema
upper airway obstruction
laryngospasm
intra-thoracic negative pressure
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Bibliografia
[1.]
A.F. Broccard, L. Liaudet, J.D. Aubert, P. Schnyder, M.D. Schaller.
Negative pressure post-tracheal extubation alveolar haemorrhage.
Anesthesia and Analgesia, 92 (2001), pp. 273-275
[2.]
D.G. Lorch, S.A. Sahn.
Post-extubation pulmonary oedema following anaesthesia induced by upper airway obstruction. Are certain patients at increased risk?.
Chest, 90 (1986), pp. 802-805
[3.]
P.N. Cascade, G.D. Alexander, D.S. Mackie.
Negative–pressure pulmonary oedema after endotracheal intubation.
Radiology, 186 (1993), pp. 671-675
[4.]
R.O. Perez, C. Bresciani, C.E. Jacob, et al.
Negative pressure post-extubation pulmonary oedema complicating appendectomy in a young patient: case report.
Current Surgery, 61 (2004), pp. 463-465
[5.]
R.K. Stoelting, S.F. Dierdorf.
Anesthesia and co-existing disease, 4, Churchill Livingstone, (2002),
Copyright © 2009. Sociedade Portuguesa de Pneumologia/SPP
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Are you a health professional able to prescribe or dispense drugs?