Pulmonary Edema Associated With Upper Airway Obstruction

We retrospectively surveyed records of 153 patients with croup or epiglottitis. Thirty-four children required intubation of the trachea to relieve upper airway obstruction. In those requiring intubation, pulmonary edema occurred in four (12%) of 34. Review of 17 previously reported cases, along with our patients, demonstrated that onset of pulmonary edema due to upper airway obstruction usually follows intubation. A PaO2 below 50 mm Hg is observed in 38% and pneumothorax in 24% of all reported cases. Supplemental oxygen, positive end-expiratory pressure, mechanical ventilation, and chest tube drainage have prevented death despite these life-threatening complications.