Negative Pressure Pulmonary Oedema: Management in Resource-Challenged Hospital: Two-Case Reports

摘要

Negative Pressure pulmonary oedema (NPPO) is a medical emergency. It occurs when there is a strong inspiratory effort in obstructed upper airway. Laryngospasm is the main cause of postextubation negative pressure pulmonary oedema. Though it is life-threatening, early diagnosis and prompt treatment lead to rapid resolution with no residual respiratory complications. The mainstay management is to provide respiratory support, mostly in the intensive care unit. The recommended mode of respiratory support is to provide an invasive or non-invasive positive airway pressure. This requires the use of a ventilator. Most surgery centres in sub-Saharan Africa do not have intensive care unit or ventilators in their recovery wards. We report two cases of postextubation NPPO which occurred in a typical African hospital with no ventilator. All these two cases were successfully managed with a non-rebreather mask. The periods of resolution, both clinical and radiological, were 24 - 48 hrs. This is not significantly different from the resolution periods quoted in literature from cases managed in well-resourced centres with means of positive pressure ventilation. We therefore conclude that early detection and prompt initiation of management are important keys which can lead to good outcomes, even in low-resource centres.