Negative Pressure Pulminary Edema

Did anyone have it when they woke up from their surgery and how long did it take to go away if you did? 

I've treated it in my own patients 2 or 3 times. The age and overall health of the patient has a lot to do with how quickly it clears.

In a  young, non-smoking individual with good heart function, the condition may not require anything other than monitoring in an ICU overnight.  If the condition is serious enough to require prolonged ventilatory support (i.e. staying on the breathing machine) you are looking a at least 24 hours of ICU care.

Those of you that remember my patient Ramon on BIg Medicine may remember thta he stayed in ICU overnight on the ventilator but was OK late te next afternoon.  We are not exactly sure, but feel that negative pressure  PE had a lot to do with his problems.

This is one of those things that occur now and then, and make me really glad I do my cases in a hospital where there is a critical care doc in-house 24 hours.

I have a history of obstructive sleep apnea which started with weight gain & resolved with weight loss.  However, I also have a history of central sleep apnea.  I no longer use CPAP since central sleep apnea is not resolved with CPAP. 

I have had trouble with apnea episodes when waking up from anesthesia before.  However, I have never had edema before. 

I had my plastic surgery (tummy tuck w/ lipo & breast augmentation w/ implants).  When waking from my plastic surgery Thursday, I had negative pressure pulminary edema (NPPE). 

From what I have read, 60% of fatalies from NPPE are from cases where patients have been misdiagnosed or undiagnosed.  (From my researching this condition, apparently many surgeons miss this because it is so incredibly rare.  I read that it only happens in 1/2 of a 10th of a percent of the population.) 

Thankfully, my sugereon correctly diagnosed me and I was kept on oxygen until my O2 levels stayed in the upper 90s for a while.  Then he allowed me to go home.  That was Thursday night and I am still coughing up clumps of blood (from what I have read, this is the main indicator of NPPE). 

He & his nurse provided me and my mother with their personal cell phone numbers.  I am sleeping with an oxygen machine each night because it is helping break the stuff still in my lungs up. 

When something worries me, I research it to death.  So I have spent almost every waking moment since my surgery researching this condition. 

Some websites call it a disease, but most just consider it a temporary complication.  All agree that it can be fatal.  I read about patients having to be re-intubated or in ICU for several days on oxygen therapy. 

I was just curious as to whether or not anyone else had had it to see about how long they had to sleep or stay on the oxygen machine.  (I don't care for it because it is drying my nose up! LOL)

I'm so glad you answered this though.  Most of the websites said that this was an EXTREMELY rare complication of various conditions (heart disease, trama, anesthesia, etc).  I had honestly never heard of it.  My surgeon has never had anybody experience this.  Apparently, it is most common in healthy men in their 20s - 30s. 

I have also read that it is starting to happen more often with patients receiving anesthesia - some websites state that this is probably because of the way the methods and medications have changed. 

My surgeon does NOT do his surgeries in the hospital (although he is right across the street from the hospital).  He does it in his own operating room in his clinic.  And since he had never seen this before, I really thank god that he correctly diagnosed me. 

Your research is correct, most series report it as a rare complication, and I agree that its not a "disease" but rather a reversible process.  I have personally seen it in 3 of my patients, and to date I have performed around 7,000 cases as surgeon, which puts me at significantly less than a 10th of a percent. 2 of the 3 were WLS patients and were in the past 2 years. 

Your also seem well aware that early diagnosis and prompt intervention are critical.  If a patient is not being monitored very closely, and the doctor attributes the inital arterial desaturation (low oxygen) to any one of a number of more common causes (narcotics, residual anesthesia, smoking, etc) things can rapidly get out of hand. 

A prompt chest xray and arterial blood gas determination must be done, and done fast.  That has to be followed by re-intubation and ICU admission where indicated, as the condition may worsen before it gets better.

Your residual bloody sputum is not uncommon, and your doc has probably told you that your chest x-ray will not improve for some time.  You will look better before it does !  I'm not sure there are any long term effects, assuming no pneumonia developed. 

My suspicion is that WLS patients with a history of obstructive sleep apnea are at increased risk although that data is not out there yet.  Longer cases, where IV fluids are given over many hours may also increase the chance of pulmonary edema.

Can large plastic surgery cases be done in a clinic settting ? Yes, and they frequently are. 

Would it make a difference in the outcome if a complication occurred ? Sadly, serving as an expert witness on several recent cases, it does.

Please keep us posted !

I did warn them beforehand that I had had trouble with episodes of apnea when coming out from under anesthesia before. 

They said from now on I need to also warn any future surgeons/anesthesiologists that may treat me that I now have a history of NPPE.  That makes me worry that this may happen to me again if I ever have another surgery.  (I don't plan any more surgeries - but I still worry in case I ever have to have another surgery that I didn't plan.)

My research shows that most people who get this are healthy individuals and studies show that there is no "common thread" that causes people to be more prone to this than others.  But I have to say that I definately agree with you that SURELY having a history of sleep apnea would make a person more likely to have this happen.  How could it not?  I really believe that they will eventually determine that there IS an increased risk of this happening in people with a history of obstructive sleep apnea. 

That also got me to thinking - is there anything a person could do as a pre-op to make themselves LESS at risk for this?  I'm thinking from what I've read that there probably isn't anything a person can do really.  Various things (non-surgically related things) can cause NPPE.  And most people that develope it are healthy individuals.

One study I read actually stated that the stronger your lung muscles are the more likely you are to have this because your muscles are capable of physically working harder to breath when obstructed.  That just sounded weird to me - but I guess it sort of made sense.

I don't even smoke or anything and had this happen to me!  I am wondering how long I will be coughing up this stuff and when I can relax and know that I am "out of danger" of developing pnuemonia or something.