Acute Negative Pressure Pulmonary Edema (NPPE) in a 14‐Year‐Old Boy Following Laparoscopic Appendectomy—A Clinical Challenge and a Proposal for Mechanical Ventilation

Negative pressure pulmonary edema (NPPE) is a rare but potentially life‐threatening complication resulting from the generation of markedly negative intrathoracic pressure in response to upper airway obstruction (UAO). This leads to disruption of the alveolar–capillary barrier and transudation of fluid into the alveolar spaces. The complex pathophysiology and the absence of clear management guidelines complicate treatment. We present the case of a previously healthy 14‐year‐old boy who developed NPPE following laparoscopic appendectomy. Mechanical ventilation in pressure support ventilation (PSV) mode with escalation of positive end‐expiratory pressure (PEEP) up to 14 cmH2O was employed, allowing avoidance of admission to the intensive care unit. Pharmacotherapy played a secondary and limited role. Rapid recognition of acute UAO and prompt restoration of adequate gas exchange proved crucial, resulting in discharge in good general condition without neurological deficits.