1 Specialist Physician (Intensivist), Aster Al Raffah Hospital, Muscat, Oman.
2 Specialist General Surgeon, Aster Al Raffah Hospital, Muscat, Oman.
3 Specialist Anaesthesiologist, Aster Al Raffah Hospital, Muscat, Oman.
BACKGROUND
Negative pressure pulmonary oedema (NPPE) is no doubt a rare and life-threatening complication following general anaesthesia in mostly otherwise healthy individuals. It has an incidence of 0.05-0.1% of general anaesthesia cases with tracheal intubation1. An undiagnosed NPPE carries a risk of around 40% mortality2. Typically it is witnessed immediately after extubation (76%) or during the initial airway management (26%) in patients with head and neck tumours, Ludwig angina or laryngospasm. It can follow elective general anaesthesia after intubation while the patient is on a ventilator. However, rarely, as in our case, the onset is delayed. Our patient developed cough and haemoptysis with expectoration in the recovery room 3 hours after an uneventful removal of the patient’s LMA at emergence and following monitoring in the Post-Anaesthesia care unit (PACU). The patient woke from sleep with bouts of cough and haemoptysis with expectoration of about 6 tablespoons of frank blood causing respiratory distress with desaturation.
Negative pressure pulmonary haemorrhage (NPPH) is a rarer. Based on the patient’s clinical findings, lab works, X-rays, CT scans and history, we suspect the diagnosis of negative pressure pulmonary oedema leading to alveolar haemorrhage.
