Das postobstruktive Lungenödem als Komplikation einer Endotrachealtubusokklusion

Zusammenfassung.

Das postobstruktive Lungenödem ist eine bedrohliche Komplikation akuter oder chronischer Obstruktionen der oberen Atemwege. Pathophysiologisch liegt dem Ödem eine extreme Erniedrigung des Pleuraldrucks durch eine frustrane Inspiration gegen die geschlossene Glottis oder die obstruierten oberen Atemwege zugrunde. In dem vorliegenden Fall entstand bei einem 15jährigen Jungen ein Postobstruktionsödem während der Ausleitung durch Tubusbiss bei massiver Exzitation. Wichtigste therapeutische Maßnahmen sind das sofortige Lösen der Obstruktion, die rasche Reoxigenierung ggf. unter Reintubation sowie die Beatmung mit PEEP oder die Applikation von CPAP. Die Kenntnis dieses Krankheitsbildes schärft die Vigilanz und hilft Risikopatienten zu identifizieren, bei denen eine entsprechende Prävention die bedrohliche Komplikation vermeiden kann.

Post opstructive Pulmonary Edema - Complication after Endotracheal Tube Obstruction.

Pulmonary edema following acute or chronic upper airway obstruction is a threatening complication. A case is presented in which a 15 year old boy developed a massive pulmonary edema after a acute endotracheal tube obstruction during emergence from anesthesia. Leading pathophysiologic cause for the formation of the edema is a markedly negative intrapleural pressure due to the forceful inspiration against the obstructed airway. Treatment modalities include the instantaneous solution of the obstruction, a rapid reoxigenation and the ventilation with PEEP or CPAP. Sound knowledge of the disease increases the vigilance of the caring anaesthesiologist and helps to identify patients at risk. Preventing measures may further reduce the risk of occurrence of the postobstructive pulmonary edema.

Schlüsselwörter:

Atemwegsobstruktion - Lungenödem - Laryngospasmus

Key words:

Airway obstruction - Pulmonary edema - Laryngospasm

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