Post obstructive pulmonary edema in children: Why should the otolaryngologist think about it?

Abstract

Introduction: Post-obstructive pulmonary edema (POPE) or by Negative Pressure, is
a potentially fatal entity that develops immediately after a severe obstruction of the
upper airway. Materials and methods: Description of a series of four cases of POPE
in children, three of them secondary to foreign body aspiration and the remaining
one as a complication of adenotonsillectomy. Discussion: The most common etiology
of airway obstruction is laryngospasm associated to airway manipulation during
intubation or airway surgery. Both adenotonsillectomy and removal of foreign bodies
in the airway are one of the most common procedures in otorhinolaryngology
practice for management of airway obstruction, however, they can potentially develop
EPPO. Conclusion: Although airway foreign bodies in children usually present
with sudden episode of choking, paroxysmal cough and/or respiratory distress, the
likelihood of an unwitnessed foreign body aspiration event in the presence of unexplained
pulmonary edema should also be considered. Although adenotonsillectomy
is one of the most common surgeries in ENT practice, it can potentially be complicated
by EPPO. We emphasize the importance of the otorhinolaryngologist keeping
this condition in mind in children who present respiratory distress after any obstruction
or surgical intervention of the airway.