Author: Shaikh N, et al.
Cureus 17(9): e91868, September 08, 2025. doi:10.7759/cureus.91868
This narrative review examines negative-pressure pulmonary edema (NPPE), a rare but potentially fatal perioperative complication most often seen after extubation. NPPE results from forceful inspiratory efforts against an obstructed glottis, generating extreme negative intrathoracic pressure that draws fluid into the alveoli. It is non-cardiogenic and unrelated to fluid overload. Typical presentations include acute respiratory distress, hypoxemia, and pink frothy sputum, with imaging showing diffuse infiltrates. Risk factors include young age, male sex, upper airway surgery, and post-extubation laryngospasm.
Management depends on severity. Many cases resolve with oxygen and non-invasive ventilation, while severe cases may require intubation, invasive ventilation with PEEP, or extracorporeal membrane oxygenation. β-agonists may accelerate alveolar fluid clearance, but diuretics are not routinely indicated as they can worsen dehydration. Prevention strategies include careful airway suctioning before extubation, minimizing laryngoscopy attempts, considering deep or awake extubation, and using lidocaine or dexamethasone to reduce laryngeal irritation and edema.
What You Should Know:
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NPPE occurs most often post-extubation, typically triggered by laryngospasm or airway obstruction.
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Rapid recognition and airway management are essential to reduce morbidity and mortality.
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Non-invasive ventilation resolves many cases; severe cases may require invasive ventilation or ECMO.
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Prevention relies on meticulous airway management and extubation strategies.
Thank you to Cureus for allowing us to use this article.