Acute negative pressure pulmonary edema after total thyroidectomy: case report

Background: Negative pressure pulmonary edema after acute upper airway obstruction is a well-described event, thought infrequently diagnosed and reported. This report aimed at presenting a case of post-extubation negative pressure pulmonary edema with successful therapeutic after using positive pressure invasive mechanical ventilation. Case report: A female patient, 59 years old, underwent thyroidectomy with bilateral dissection. Preoperative exams showed no abnormalities. Immediately after extubation, the patient presented with sudden dyspnea and pulmonary crackles, being reintubated, transferred to the ICU, and subsequent tracheostomy. She was discharged home with a metal cannula and two months later its removal was performed. Conclusion: NPPE is a difficult entity to diagnose and should be observed whenever patients develop signs and symptoms of post-extubation respiratory failure. Early diagnosis, reintubation and subsequent tracheostomy allowed patients to return to their activities two months after the metal cannula was removed.