Respir Case Rep. 2015; 4(2): 136-140 | DOI: 10.5505/respircase.2015.20982

Nonkardiyojenik Akciðer Ödeminin Nadir Bir Nedeni Olan Negatif Basýnçlý Pulmoner Ödem: Ýki Olgu Sunumu

Levent Özdemir¹, Burcu Özdemir², Hakan Karabay³, Senem Urfalý³, Resul Akyol³, Zulal Özbolat¹, Yusuf Kýlýnç⁴, Sema Nur Çalýþkan², Ali Ersoy⁵, Bilge Üzmezoðlu^6
1Dörtyol Devlet Hastanesi, Göðüs Hastalýklarý Kliniði, Hatay
²Ýskenderun Devlet Hastanesi, Göðüs Hastalýklarý Kliniði, Hatay
³Dörtyol Devlet Hastanesi, Anestezi ve Reanimasyon Kliniði, Hatay
⁴Dörtyol Devlet Hastanesi, Kardiyoloji Kliniði, Hatay
⁵Antakya Devlet Hastanesi, Göðüs Hastalýklarý Kliniði, Hatay
⁶Ankara Numune Eðitim ve Araþtýrma Hastanesi, Göðüs Hastalýklarý Kliniði, Ankara

Negatif basýnçlý pulmoner ödem (NBPÖ) genel anestezi sonrasýnda erken postoperatif dönemde laringospazma baðlý olarak geliþebilen, hayatý tehdit eden ve nadir gözlenen nonkardiyojenik bir pulmoner ödem sebebidir. Otuz üç yaþýnda erkek ve kýrk üç yaþýnda kadýn hastaya genel anestezi altýnda apendektomi ve kolesistektomi operasyonu uygulandý. Entübasyon ve operasyon süresince hemodinamik ve solunumsal sýkýntý yaþanmadý. Birinci olguda ekstubasyon sonrasýnda birkaç dakika içerisinde ciddi laringospazm ve þiddetli inspiratuvar efor sonrasý satürasyonunda düþme saptandý. Ýkinci olguda ise operasyondan 45dk sonra nefes darlýðý ve satürasyonda düþme sap-tandý. Her iki olgunun da fiziki muayenesinde bilateral orta ve alt zonda ralleri mevcuttu. Postoperatif çekilen akciðer ve toraks tomografilerinde akciðer ödemi ile uyumlu bulgular saptandý. Postoperatif ekokardiyografik bulgularý normaldi. Her iki olguya da beta-2 agonist, inhale steroid, oksijen ve diüretik tedavisi verildi. Postoperatif erken dönemde satürasyon düþüklüðü olan hastalarda ayýrýcý tanýda negatif basýnçlý pulmoner ödem de akýlda tutulmalýdýr.

Anahtar Kelimeler: Negatif basýnçlý pulmoner ödem, anestezi, nonkardiyojenik ödem.

---

A Rare Cause of Non-cardiogenic Pulmonary Edema Negative Pressure Pulmonary Edema: Two Case Reports

Levent Özdemir¹, Burcu Özdemir², Hakan Karabay³, Senem Urfalý³, Resul Akyol³, Zulal Özbolat¹, Yusuf Kýlýnç⁴, Sema Nur Çalýþkan², Ali Ersoy⁵, Bilge Üzmezoðlu^6
1Clinic of Chest Diseases, Dörtyol State Hospital, Hatay, Turkey
²Clinic of Chest Diseases, Ýskenderun State Hospital, Hatay, Turkey
³Clinic of Anaesthesia and Reanimation, Dörtyol State Hospital, Hatay, Turkey
⁴Clinic of Cardiology, Dörtyol State Hospital, Hatay, Turkey
⁵Clinic of Chest Diseases, Antakya State Hospital, Hatay, Turkey
⁶Clinic of Chest Diseases, Ankara Numune Training and Research Hospital, Ankara, Turkey

Negative pressure pulmonary edema (NPPE) is a life threatening rare cause of non-cardiogenic pulmonary edema that can occur due to laryn-gospasm in the early postoperative period after general anesthesia. A 33-year-old male and a 43-year-old female appendectomy and cholecystectomy were performed under general anesthesia. Hemodynamic and respiratory distress were not experienced during intubation and operation. Serious laryngospasm and a reduction in saturation after severe inspiratory effort were detected in the first patient within a few minutes after extubation. Dyspnea and a reduction in saturation were established after 45 minutes of the operation in the second patient. Patients had bilateral middle and lower zone crackles upon physical the examination. Postoperative chest and thorax tomography revealed findings consistent with pulmonary edema. Postoperative echocardiographic findings were normal. Beta-2 agonists, inhaled steroids, oxygen, and diuretic therapy were administered to patients. NPPE should also be kept in mind in the differential diagnosis in patients with low saturation in the early postoperative period.

Keywords: Negative pressure pulmonary edema, anesthesia, noncardiogenic edema.

---