@article{article_610933, title={Negative pressure pulmonary edema due to endotracheal tube bite in a patient who could not be placed guedel oropharyngeal airway before extubation.}, journal={Health Academy Kastamonu}, volume={6}, pages={51–60}, year={2021}, DOI={10.25279/sak.610933}, author={Hoşten, Tülay and Serez, Buket Yıldız}, keywords={Negative Pressure Pulmonary Edema,Biting The Endotracheal Tube,Bite Blok}, abstract={<p class="MsoNormal" align="left" style="margin-right:0cm;margin-bottom:4.8pt;"> <b> <span style="font-size:12pt;line-height:200%;font-family:’Times New Roman’, serif;color:#333333;">Background: </span> </b> <span style="font-size:12pt;line-height:200%;font-family:’Times New Roman’, serif;color:#333333;"> </span> <span lang="en-us" style="font-size:12pt;line-height:200%;font-family:’Times New Roman’, serif;" xml:lang="en-us">Acute negative pressure pulmonary edema is a
complication that usually occurs shortly after extubation in patients receiving
general anesthesia. </span> <span style="font-size:12pt;line-height:200%;font-family:’Times New Roman’, serif;color:#222222;background:#F8F9FA;">It may
also occur due to the bite of the endotracheal tube prior extubation. </span> <span style="font-size:12pt;line-height:200%;font-family:’Times New Roman’, serif;color:#333333;"> </span> </p> <p> </p> <p class="MsoNormal" align="left" style="margin-right:0cm;margin-bottom:4.8pt;"> <b> <span style="font-size:12pt;line-height:200%;font-family:’Times New Roman’, serif;color:#333333;">Case presentation:  </span> </b> <span lang="en-us" style="font-size:12pt;line-height:200%;font-family:’Times New Roman’, serif;" xml:lang="en-us">A
52-year-old male patient was scheduled for ventriculoperitoneal shunt operation.
General anesthesia was applied. Respiratory and hemodynamic variables were
stable during surgery. At the end of the surgery, anesthetic drugs were
discontinued, the lumen of the endotracheal tube and oropharynx were aspirated.
When oropharyngeal airway was placed the patient bit and occluded his endotracheal
tube, and began exerting breathing effort. Rapid desaturation was observed and
pink foamy secretion came through the endotracheal tube. Bilateral diffuse
crackles were present. A chest X-ray revealed bilateral pulmonary edema. The
patient was transferred to the intensive care unit, sedation was applied and
volume controlled positive pressure mechanical ventilation was started. The
patient was extubated at the 12 <sup>th </sup> postoperative hour and sent to the
ward on the third postoperative day. </span> </p> <p> </p> <p class="MsoNormal" align="left" style="margin-right:0cm;"> <b> <span lang="en-us" style="font-size:12pt;line-height:200%;font-family:’Times New Roman’, serif;" xml:lang="en-us">Discussion: </span> </b> <span lang="en-us" style="font-size:12pt;line-height:200%;font-family:’Times New Roman’, serif;" xml:lang="en-us"> The extubation plan should be done well. Aspiration
and extubation should be performed either under deep anesthesia or when the
patient is fully awake. Oropharyngeal airway should be placed under adequate
depth of anesthesia before extubation. Although oropharyngeal  </span> <span style="font-family:’Times New Roman’, serif;font-size:12pt;">airway reduces the risk of biting of the endotracheal
tube and subsequent development of negative pressure pulmonary edema, it may
not prevent it completely. In negative pressure pulmonary edema treatment,
invasive or non-invasive mechanical ventilation may be preferred depending on
the severity of obstruction and degree of hypoxia. Early diagnosis and
treatment of negative pressure pulmonary edema is life-saving.  </span> </p> <p class="MsoNormal" align="left" style="margin-right:0cm;"> <span style="font-size:12pt;line-height:200%;font-family:’Times New Roman’, serif;"> </span> </p> <p> </p>}, number={2}, publisher={Esra DEMİRARSLAN}