Chest Compression for Post Obstructive Pulmonary Edema: A Case Report

Moon, Hee Wan

Abstract

Post obstructive pulmonary edema (POPE) after anesthesia is a rare, but potentially dangerous pulmonary edema during or after relief of severe total or partial upper airway obstruction. The formation of POPE is believed to be the generation of negative intrapleural and intraalveolar pressures which increase the pulmonary transvascular hydrostatic pressure gradient and cause fluid movement to the interstitium and alveoli. Because of both the rapidity and severity with which POPE can develop, prompt recognition and management are essential. A case of POPE after anesthesia in a 23 year-old healthy male undergoing the primary repair of T12 fracture was presented. The patient was extubated without problem after operation. Arrived at the ICU, the patient showed laryngospasm and low oxygen saturation (around 50%). After the intubation with PEEP and the suction of the big amount of pinky frothy transudates through endotracheal tube, oxygen saturation was kept mid 70 s for over 30 minutes. After about 10 times chest compression with suctioning through endotracheal tube, the patient's oxygen saturation showed mid 90 s. This chest compression for the POPE was not recognized by the reference. Even though I can not tell the advantage or disadvantage of this treatment, I report this case for the future reference. After reviewing the reference, the risk factors, differential diagnosis, management and prevention of POPE are discussed.