Severe Pulmonary Edema Following Extraction of a Tracheal Foreign Body: A Case Report

We report the case of a 42-year-old man with a history of tracheal stenosis secondary to prolonged orotracheal intubation. He was then tracheotomized for acute respiratory distress. He subsequently underwent tracheoplasty and multiple tracheal balloon dilations, with a very satisfactory functional result. However, due to his critical lung condition, decannulation was deferred. The patient presented to our emergency department in acute respiratory distress, following a direct blow to his neck. A quick physical assessment revealed a loosely hanging tracheostomy-tube-plate around his neck. He was immediately transferred to the operation room and the cannula was extracted through cervical and bronchoscopic approach. A fenestrated cuffed #6 tracheostomy tube was inserted, and the patient was stabilized. Fifteen minutes later, we started observing a rapid drop in O2 saturation from 98% to 60%. A chest X-ray revealed a severe pulmonary edema. Despite appropriate treatment, the oxygen saturation was barely reaching 60% and he presented a cardio-respiratory arrest. Post obstructive pulmonary edema (POPE) is a potentially life-threatening acute respiratory failure. Two types of POPE are described: type I caused by increased inspiratory effort from acute airway obstruction and type II, caused by sudden relief of a chronic partial airway obstruction. To our knowledge, only two cases of type Ⅱ POPE secondary to the removal of a bronchial foreign body in the last 2 decades were reported. The diagnosis is based on the patient's medical history, clinical characteristics, and radiological results. Treatment strategy will include endotracheal intubation and positive pressure ventilation with supplemental oxygen.