This article presents the case of a 15-year-old boy undergoing laparoscopic appendectomy for phlegmonous appendicitis. During extubation a drop in arterial oxygen saturation (SaO2) occurred due to... Show moreThis article presents the case of a 15-year-old boy undergoing laparoscopic appendectomy for phlegmonous appendicitis. During extubation a drop in arterial oxygen saturation (SaO2) occurred due to the boy biting on the tube. Radiologically, a pulmonary edema was suspected. Ventilation with continuous positive airway pressure (CPAP) and assisted spontaneous breathing (ASB) on the following day led to complete normalization of the patient's condition. The diagnosis of negative pressure pulmonary edema, a complication of acute and chronic obstruction of the upper airways was made. The pathophysiological mechanism of negative pressure pulmonary edema is the development of a pronounced negative (lower than the surrounding pressure) intrapleural pressure during inspiration against the closed glottis. The incidence is between 0.05 and 0.1 % but is probably much higher and the therapy is symptomatic. Show less
