Acute Pulmonary Edema Caused by Choking in an Adult Patient

阻塞後肺水腫(post-obstructive pulmonary edema)或稱為負壓性肺水腫(negative pressure pulmonary edema)是病患發生上呼吸道阻塞後潛在致命的併發症。此症可能急性無預警地發生在狀況似乎良好的病患。此病症於成年人仍鮮少被報導。在此我們報告一於吃麻糬嗆到之病患，予以暢通呼吸道後，卻發生肺水腫的臨床表徵，此病患經保守治療後迅速恢復，判斷為因呼吸道阻塞後所發生之非心因性肺水腫。阻塞後肺水腫之處置以避免再度阻塞，輔助換氣，提供氧氣及支持治療為主，通常預後良好；即使在上呼吸道阻塞緩解之後，臨床醫師仍應持續注意病患的呼吸狀況，並應留觀至少六小時。瞭解此狀況亦可避免與急性肺損傷／急性呼吸窘迫症候群混淆，而導致不必要的治療甚至醫源性的併發症。

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並列摘要

Postobstructive pulmonary edema (POPE), otherwise known as negative pressure pulmonary edema (NPPE), is a potentially life-threatening complication following acute upper airway obstruction (UAO). It can develop rapidly, without warning, in persons who are otherwise well. Although POPE was first described nearly 30 years ago, yet this perplexing syndrome is rarely reported in adult. We report an adult patient who suffered from choking with a Chinese dessert. He developed a non-cardiogenic pulmonary edema due to acute upper airway obstruction and recovered well after conservative treatment. Clinicians should be alert to continued respiratory symptoms following relief of acute airway obstruction. Preventing re-obstruction and providing adequate ventilation and oxygenation are mandatory. Such patients should be observed in ED for at least 6 hours in order to avoid a catastrophic outcome. Awareness of this condition can avoid unnecessary intervention and possible iatrogenic complications coming from treating ALI/ARDS.

並列關鍵字

Postobstructive pulmonary edema ； Negative pressure pulmonary edema ； Noncardiogenic pulmonary edema ； Airway obstruction ； Choking

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Acute Pulmonary Edema Caused by Choking in an Adult Patient

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