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      Case Report: Post obstructive pulmonary edema (POPE) Type II following elective adenotonsillectomy requiring novel use of high frequency oscillatory ventilation (HFOV)

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          Abstract

          This case report describes a previously healthy 14 year-old patient undergoing elective outpatient adenotonsillectomy that was complicated by acute postoperative pulmonary edema requiring 12 hours of high frequency oscillatory ventilation (HFOV) support.  We describe the clinical findings that led us to this rare diagnosis and management of post obstructive pulmonary edema (POPE) Type II, a rare but recognized complication following the surgical relief of an upper airway obstruction. This case is unique in that no previously published case report or review of POPE Type II has described the need for HFOV support.

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          High frequency oscillation in patients with acute lung injury and acute respiratory distress syndrome (ARDS): systematic review and meta-analysis

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            Postobstructive pulmonary edema

            Postobstructive pulmonary edema (POPE; also known as negative pressure pulmonary edema) is a potentially life-threatening complication in which pulmonary edema occurs shortly after the relief of an upper airway obstruction. The incidence of POPE has been reported to be as high as 1 in 1000 general anesthetic cases and commonly presents as acute respiratory distress that requires immediate intervention. This review examines the 2 subclasses of POPE and describes the etiologic factors, pathophysiology, clinical manifestations, diagnostic criteria, and treatment strategies associated with each. The aim of this review was to equip clinicians with the knowledge base necessary to identify patients at increased risk for POPE and to expeditiously diagnose and treat this potentially catastrophic complication.
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              Postobstructive pulmonary edema after laryngospasm in the otolaryngology patient.

              Post-obstructive pulmonary edema (PPE) is an uncommon complication which develops immediately after the onset of acute airway obstruction such as laryngospasm or epiglottitis (type I) or after the relief of chronic upper airway obstruction such as adenotonsillar hypertrophy (type II). To describe the development of type I PPE following laryngospasm in pediatric and adult patients undergoing otolaryngologic surgical procedures other than those for treatment of obstructive sleep apnea. Retrospective case series of 13 otolaryngology patients from 1996 to 2003. Tertiary care teaching hospital and its affiliates. 13 patients (4 children, 9 adults, 5 males, 8 females) ranging in age from 9 months to 48 years. Operative procedures included adenoidectomy, tonsillectomy, removal of an esophageal foreign body, microlaryngoscopy with papilloma excision, endoscopic sinus surgery, septorhinoplasty, and thyroidectomy. Six patients required reintubation. Treatment included positive pressure ventilation, oxygen therapy, and diuretics. Seven patients were discharged within 24 hours and the others were discharged between 2 and 8 days postoperatively. There were no mortalities. Laryngospasm resulting in PPE may occur in both children and adults after various otolaryngologic procedures. Among the subgroup of children, our study is the first to report its occurrence in healthy children without sleep apnea undergoing elective surgery.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data CurationRole: Formal AnalysisRole: InvestigationRole: MethodologyRole: Project AdministrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – Original Draft PreparationRole: Writing – Review & Editing
                Role: ConceptualizationRole: Data CurationRole: Formal AnalysisRole: InvestigationRole: MethodologyRole: Project AdministrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – Original Draft PreparationRole: Writing – Review & Editing
                Role: ConceptualizationRole: Data CurationRole: Formal AnalysisRole: InvestigationRole: MethodologyRole: Project AdministrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – Original Draft PreparationRole: Writing – Review & Editing
                Journal
                F1000Res
                F1000Res
                F1000Research
                F1000Research
                F1000 Research Limited (London, UK )
                2046-1402
                31 August 2018
                2018
                : 7
                : 1373
                Affiliations
                [1 ]Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, T2N 2T9, Canada
                [2 ]Department of Anesthesiology, Pain, and Perioperative Medicine, Royal Jubilee and Victoria General Hospitals, Victoria, British Columbia, V8R 1J8, Canada
                [3 ]Department of Pediatric Anesthesia, Alberta Children’s Hospital, Calgary, Alberta, T3B 6A8, Canada
                [1 ]Department of Pediatric Anesthesia and Intensive Care, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
                [1 ]Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital,  University of Washington School of Medicine, Seattle, WA, USA
                Author notes

                No competing interests were disclosed.

                Competing interests: No competing interests were disclosed.

                Competing interests: No competing interests were disclosed.

                Author information
                https://orcid.org/0000-0001-7145-7284
                https://orcid.org/0000-0002-1903-3465
                Article
                10.12688/f1000research.16044.1
                6325615
                3ae2ead9-114c-4719-a53b-9c445db1e025
                Copyright: © 2018 Moser JJ et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 August 2018
                Funding
                The author(s) declared that no grants were involved in supporting this work.
                Categories
                Case Report
                Articles

                general anesthesia,high frequency oscillation ventilation,pulmonary edema,sleep apnea,obstructive tonsillitis

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