Postobstructive pulmonary edema in a 40-year-old man after suffocation by a swimming pool cover.

BACKGROUND: Postobstructive pulmonary edema (POPE) is a form of sudden onset, noncardiogenic pulmonary edema that can occur after the relief of an upper airway obstruction.

OBJECTIVE: Since POPE is an uncommon diagnosis made in the emergency department (ED), this case is presented to increase emergency physicians' awareness of the etiology, pathophysiology, and management of this type of edema.

CASE REPORT: This is a case of bilateral POPE in a 40-year-old man with no history of cardiac or pulmonary disease who experienced near suffocation due to the vacuum effect of a swimming pool cover. On presentation to the ED, the patient's symptoms included bilateral pleuritic pain over the anterior chest, shortness of breath, and inspiratory cough. He was tachycardic and tachypneic, with an oxygen saturation of 92% on room air. Pertinent physical examination findings included shallow breathing and right-sided rhonchi. The initial arterial blood gas on room air demonstrated a PaO2/FiO2 ratio of 304 mm Hg. Cardiac enzymes and the electrocardiogram result were normal. The patient's chest radiograph was interpreted as having marked bilateral pulmonary edema. The patient was admitted to the Medicine Intensive Care Unit and placed on noninvasive positive pressure ventilation (NIPPV). The patient was clinically asymptomatic and was discharged after 72 h.

CONCLUSIONS: Emergency physicians should consider the diagnosis of POPE in a symptomatic patient if there is evidence of pulmonary edema immediately after a history of hanging, suffocation, strangulation, choking, naloxone administration, or other forms of upper airway obstruction. Rapid initiation of NIPPV with or without diuretics, steroids, or fluid restriction can lead to symptom resolution within 24 to 48 h.