Chest
Clinical Investigations in Critical CareFatal Postoperative Pulmonary Edema: Pathogenesis and Literature Review
Section snippets
Materials and Methods
There were 13 study patients who, from 1991 to 1996, had postoperative pulmonary edema documented by clinical criteria and characteristic findings on chest radiograph. The diagnosis was confirmed by autopsy in nine patients and by pulmonary artery catheterization in four. Demographic features are shown in Table 1. There were four men and nine women, and the average age (± SD) was 38 ± 21 years. The operations are shown in Table 1. All but one operation (patient 9) were elective. All patients
Postoperative Patients With Fatal Pulmonary Edema
All results are presented as mean ± SD. In eight patients, the initial manifestation of pulmonary edema was cardiopulmonary arrest requiring emergent intubation (Table 1). One patient had intraoperative chest pain, three had acute florid pulmonary edema, and one had acute renal failure. The diagnosis of acute pulmonary edema was established by a diagnostic chest radiograph accompanied by typical physical findings of bilateral rales, a third heart sound, and copious pink frothy sputum in three
Discussion
These data demonstrate that in generally healthy individuals undergoing elective surgery, pulmonary edema may be the initial clinical manifestation of fluid overload. If the pulmonary edema is not recognized and treated promptly, the patients may not survive. Although most textbooks of surgery recognize that excessive postoperative fluid administration can cause pulmonary edema, essentially no guidelines are available as to the quantity of fluid that may lead to such a complication.17 There are
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Supported by a grant RO1 AG 08575-01A2 fromthe National Institute on Aging, Department of Health and Human Services, Bethesda, MD.