Pulmonary edema is a rare complication of acute upper airway obstruction. This serious complication must be carefully recognized and treated promptly to minimize the delayed morbidity and mortality among the patients who recover from acute upper airway obstruction. We present a case of noncardiogenic pulmonary edema that developed in an 1.4/12-year-old pediatric patient after an episode of acute upper airway obstruction.
Airway Obstruction ; Humans ; Mortality ; Pulmonary Edema*

Pulmonary Edema is a complication of acute upper airway obstruction secondary to laryngospasm. This serious complication is treated promptly to minimize the delayed morbidity and mortality among the patients. Acute pulmonary edema followed the event in minutes to hours and required ventilatory assistance to maintain oxygenation. All patients eventually respond to fluid restriction diuretics and steroids. We present a case of pulmonary edema that occured in a 37 years old healthy adult after extubation caused by a laryngospasm.
Adult ; Airway Obstruction ; Diuretics ; Edema ; Humans ; Laryngismus ; Larynx ; Lung ; Mortality ; Oxygen ; Pulmonary Edema* ; Spasm ; Steroids

BACKGROUND: Stress-induced cardiomyopathy (SCM) is characterized by apical ballooning on echocardiography, but some of SCM patients show non-apical involvement and their characteristics are not well defined. METHODS: We investigated 56 patients that were diagnosed as SCM and divided them into 2 groups: apical ballooning syndrome (ABS, n = 49, 87.5%) and non-apical ballooning syndrome (N-ABS, n = 7, 12.5%) groups. Patients with N-ABS were significantly younger than those of the ABS group (52 +/- 11 vs. 73 +/- 10 years, p < 0.001). RESULTS: Types of preceding stressors and clinical presentation including chest pain, pulmonary edema, cardiogenic shock and in-hospital mortality were comparable between the two groups. In the N-ABS group, wall motion score index was significantly lower than in the ABS group (1.61 +/- 0.35 vs. 1.93 +/- 0.31, p = 0.016). On electrocardiogram (ECG), T-wave inversion (57.1% vs. 95.8%, p < 0.001) were less frequent in the N-ABS than in the ABS group. Furthermore, maximum QT and corrected QT (QTc) intervals in the N-ABS patients were significantly shorter than the ABS patients (QT, 419.9 +/- 66.1 vs. 487.3 +/- 79.6 ms, p = 0.038; QTc, 479.0 +/- 61.9 vs. 568.0 +/- 50.5 ms, p < 0.001). CONCLUSION: Patients with the N-ABS showed not only atypical echocardiographic findings, but also atypical clinical and ECG manifestations. Integrated consideration is needed to reach a diagnosis of the non-apical subtype of SCM.
Chest Pain ; Echocardiography ; Electrocardiography ; Hospital Mortality ; Humans ; Pulmonary Edema ; Shock, Cardiogenic ; Takotsubo Cardiomyopathy*

Pulmonary thrombo-embolism in operating room is one of the important cause of morbidity and mortality in patients undergoing femur neck fracture surgery. However, the diagnosis of pulmonary thromboembolism may not be easy because sudden shock can have many different causes (e.g. myocardial infarction, hypovolemia, pneumothorax, non-cardiogenic pulmonary edema, pulmonary thrombo- embolism) and specialized diagnostic tools are not readily available in the operating room. Rapid and accurate diagnosis of pulmonary thromboembolism is very important in outcome of patients. We report a case in which pulmonary thromboembolism under spinal anesthesia occured just before the beginning of operation.
Anesthesia, Spinal* ; Diagnosis ; Femoral Neck Fractures ; Humans ; Hypovolemia ; Mortality ; Myocardial Infarction ; Operating Rooms ; Pneumothorax ; Pulmonary Edema ; Pulmonary Embolism* ; Shock

Although symptoms related to airflow obstruction are the most prominent symptoms in patients with chronic obstructive pulmonary disease (COPD), there are many local and systemic complications contributing to the morbidity and mortality of the patients. This review article briefly discusses the following complications of COPD and their clinical implications: change of pulmonary circulation, peripheral edema, systemic inflammation, cardiovascular complication, weight loss, skeletal muscle dysfunction, osteoporosis, and anxiety. A better understanding and management of these complications as well as treatment of the airflow obstruction can improve the quality of life, and even the survival of the patients.
Anxiety ; Edema ; Humans ; Inflammation ; Mortality ; Muscle, Skeletal ; Osteoporosis ; Pulmonary Circulation ; Pulmonary Disease, Chronic Obstructive* ; Quality of Life ; Weight Loss

Mortality rate for pulmonary embolectomy in critically ill patients still ranges from 30% to 45%. The causes of death in these patients are persistent pulmonary hypertension, pulmonary edema, and massive pulmonary hemorrhage. Residual thrombus and air trapping in peripheral pulmonary artery during pulmonary embolectomy can cause intractable right heart failure and persistent pulmonary hypertension. We report a successful extraction of residual thrombus and air bubbles during pulmonary embolectomy by retrograde pulmonary perfusion. Use of this technique could decrease morbidity and mortality from persistent right heart failure after pulmonary embolectomy in critically ill patients.
Cause of Death ; Critical Illness ; Embolectomy* ; Heart Failure ; Hemorrhage ; Humans ; Hypertension, Pulmonary ; Mortality ; Perfusion* ; Pulmonary Artery ; Pulmonary Edema ; Pulmonary Embolism* ; Thoracic Surgery ; Thrombosis

OBJECTIVETo evaluate the efficacy of noninvasive ventilation on in-hospital mortality in adult patients with acute cardiogenic pulmonary edema (ACPE) .

METHODSWe searched PubMed, Embase, Wanfang, CNKI data to find relevant randomized controlled trials of noninvasive ventilation for ACPE, which were reported from January 1980 to December 2012. Meta-analysis was performed with software of RevMan 5.1.

RESULTSAccording to inclusive criteria and exclusion criteria, 35 randomized controlled trials with 3 204 patients were enrolled for analyses. Meta-analysis of the trials showed that continuous positive airway pressure (CPAP) reduced in-hospital mortality by 43% (RR = 0.57, 95%CI 0.43-0.75, P < 0.01) and bilevel positive pressure ventilation (BiPAP) reduced mortality by 31% (RR = 0.69, 95%CI 0.51-0.94, P = 0.02) compared with standard therapy. There were no significant differences in in-hospital mortality between BiPAP and CPAP (RR = 1.09, 95%CI 0.80-1.49, P = 0.57) and myocardial infarction rate (BiPAP vs. CPAP: RR = 1.20, 95%CI 0.95-1.52, P = 0.12; BiPAP vs. standard therapy: RR = 1.10, 95%CI 0.88-1.38, P = 0.40).

CONCLUSIONNoninvasive ventilation (BiPAP and CPAP) could reduce in-hospital mortality of adult patients with ACPE, which could be used as first-line management strategies for these patients.

BACKGROUND: Most stroke-related deaths occur shortly after the onset of symptoms. Analysis of early deaths after stroke is important, since some deaths may be preventable. It also helps to improve the quality of stroke management. We investigated the early mortality and the causes of death in acute ischemic stroke patients. METHODS: We reviewed the medical records of six hundred fifty-one consecutive acute ischemic stroke patients who admitted to HLMC (Hallym University Medical Center) between January 1993 and December 1996. The 30-day mortality rate and the cause of death in each case were assessed. RESULTS: Fifty patients (mean age, 67.7 years, male : female=1 : 1.3) of total 651 patients (mean age, 65.4 years, male : female=1:0.78) died within 30 days (7.7%). Thirty-three (7%) patients of the 471 patients who had supratentorial lesion and sixteen (10.5%) of the 151 patients who had infratentorial lesion died within 30 days. The 30-day mortality rate according to each stroke subtype were 8.2% in large-artery atherosclerosis (n=21), 26.4% in cardioembolism (n=14), 1.2% in small-vessel occlusion (n=3), 33.3% in strokes with other determined etiology (n=1), 12.1% in strokes with undetermined etiology (n=11). Twenty-eight patients (56%) died due to direct stroke-related causes such as herniation, evolving stroke and massive hemorrhagic transformation. Twenty-two patients (44%) died from indirect stroke-complicated causes such as sepsis (n=7, 14%), heart disease (n=6, 12%), pneumonia (n=5, 10%), massive bleeding at tracheostomy site (n=1, 2%), pulmonary edema (n=1, 2%) and unknown cause (n=2, 4%). Forty patients (80%) died in the first 10 days and the main causes of death were herniation and evolving stroke. After the first 10 days, ten patients (20%) died of relative immobility (pneumonia, sepsis, pulmonary embolism). CONCLUSION: To reduce the early mortality within the first 10 days after the onset, aggressive control of IICP with the amelioration of brain edema must be emphasized. Whilst, to reduce the early mortality after the first 10 days, vigorous efforts to prevent and treat complications, such as pneumonia, pulmonary embolism and sepsis should be done.
Atherosclerosis ; Brain Edema ; Cause of Death* ; Cerebral Infarction ; Heart Diseases ; Hemorrhage ; Humans ; Male ; Medical Records ; Mortality* ; Pneumonia ; Pulmonary Edema ; Pulmonary Embolism ; Sepsis ; Stroke* ; Tracheostomy

Adult Respiratory Distress Syndrome(ARDS) is defined as a syndrome of acute respiratory failure characterized by noncardiogenic pulmonary edema with severe hypoxemia caused by right to left intrapulmonary shunting secondary to atelectasis and air space filled with edema fluid. On the past respiratory failure was thought to be the most common cause of mortality of ARDS in the past but recent research suggests the importance of non-pulmonary organ failure. And this has been increasingly recognized as a major cause of death in patients who develope a acute lung injury. Therefore the prognosis of ARDS depends on the associated clinical disorders. But there are very few reports about the prognosis and predisposing factor of ARDS in korea. We performed a retrospective study on ARDS in association with sex prevalance, in 103 ARDS patients. Age distribution, associated disease and prognosis. The results were as follows l) ARDS occurred more frequantly in male.(male female=1.9: 1) 2) Common clinical disorders associcated with development of ARDS were sepsis(26%), pneumonia(16%), gastric aspiration(12%) and etc. 3) Overall mortality was 54%, but the mortality was high in trauma patient with 80%. 4) Mortality of ARDS increased by age.
Acute Lung Injury ; Adult* ; Age Distribution ; Anoxia ; Causality* ; Cause of Death ; Edema ; Humans ; Korea ; Mortality ; Prognosis* ; Pulmonary Atelectasis ; Pulmonary Edema ; Respiratory Distress Syndrome, Adult* ; Respiratory Insufficiency ; Retrospective Studies

Chronic thromboembolic pulmonary hypertension (CTEPH) is considered to be an aberrant outcome of acute pulmonary thromboembolism, due to inadequate thrombus dissolution. However, the mechanism of thrombi dissolution failure remains unclear. With respect to inherited thrombophilia, the co-occurrence of natural anticoagulant deficiencies with CTEPH was found to be rare. Pulmonary thromboendarterectomy (PTE) is a potentially curative surgical procedure for CTEPH, but it is associated with considerable mortality due to postoperative complications, such as reperfusion pulmonary edema and right heart failure. The postoperative course after PTE poses a unique series of ventilatory care and hemodynamic management challenges. We present the case of a 42-year-old woman with unilateral CTEPH combined with thrombophilia (Protein S deficiency). Successful PTE was followed by independent lung ventilation with unilateral nitric oxide (NO) inhalation, which resulted in functional improvement without postoperative complications.
Adult ; Endarterectomy* ; Female ; Heart Failure ; Hemodynamics ; Humans ; Hypertension, Pulmonary* ; Inhalation ; Lung ; Mortality ; Nitric Oxide ; Postoperative Complications ; Protein S Deficiency ; Pulmonary Edema ; Pulmonary Embolism ; Reperfusion ; Thrombophilia ; Thrombosis ; Ventilation