NEGATIVE PRESSURE PULMONARY OEDEMA AFTER NASOTRACHEAL EXTUBATION IN A DENTAL SURGERY: A CASE REPORT

Negative pressure pulmonary oedema (NPPE) following upper airway obstruction after extubation has been described in multiple clinical contexts and is mainly caused by a sudden increase in negative intrathoracic pressure during vigorous inspiratory efforts against a blocked airway. We present a case of NPPE that developed after general anaesthesia for wisdom teeth extraction. Shortly after extubation, the patient exhibited a marked reduction in tidal volume, became agitated, showed laboured and noisy breathing, and desaturated severely to 40% SpO₂. Pink, frothy secretions were noted, raising suspicion of NPPE likely secondary to acute upper airway obstruction caused by laryngospasm. Immediate supportive treatment with continuous positive airway pressure (CPAP) was started to improve oxygenation. Initial medical management included diuretics, vasodilators, corticosteroids, and non-invasive ventilation. Due to worsening hypoxemia and hemodynamic instability, the patient was shifted to the intensive care unit (ICU) where she was intubated and mechanically ventilated. An elevated procalcitonin level suggested an underlying possible bacterial infection, prompting initiation of empirical broad-spectrum antibiotics. Over the following days, the patient’s respiratory status and hemodynamics gradually improved. She was successfully extubated and subsequently discharged with full recovery noted during follow-up.