Negative pressure pulmonary oedema in the medical intensive care unit

Objective. Negative pressure pulmonary oedema (NPPE) occurring in the medical intensive care unit (MICU) is an uncommon, probably under-diagnosed, but life-threatening condition. Design. Retrospective data collection. Setting. Medical intensive care unit in a 1,500-bedded tertiary care hospital. Patients and participants. Five patients were diagnosed between January 1998 and January 2002. Interventions. None. Measurements and results. Five patients were diagnosed to have NPPE from different aetiologies. These were acute epiglottitis, post-stenting of right bronchus intermedius stenosis, strangulation, compression from a goitre and one patient developed diffuse alveolar haemorrhage after biting the endotracheal tube during recovery from anaesthesia. All patients responded rapidly to supplemental oxygen, positive pressure ventilation and correction of underlying aetiologies. Pulmonary oedema resolved rapidly. Conclusions. There is a large spectrum of aetiologies causing NPPE in the medical intensive care unit.