[1][2] NPPE develops as a result of significant negative pressure generated in the chest cavity by inspiration against an upper airway obstruction.
As these structures are important for gas exchange during respiration, patients with NPPE struggle to have adequate oxygen supply to the tissues of their body.
[1][5] Interestingly, the use of sugammadex to reverse neuromuscular blockade (the mechanism of paralysis during surgery) has also been associated with increased incidence of NPPE[6] Risk factors associated with development of NPPE include male sex, younger age, increased cardiovascular fitness, and undergoing head or neck surgery.
Other causes of pulmonary edema that require rapid intervention and should be considered first include fluid overload, brain injury, and anaphylaxis.
Clinical signs supportive of upper airway obstruction such as stridor and/or wheezing in the setting of pulmonary edema point to the diagnosis of NPPE.
[5] Once the cause of obstruction and the resultant negative pressures are addresses, the rest of the management is the same as the standard care to relieve pulmonary edema.