Postobstruction Pulmonary Edema in Pediatric Patients

Case Synopsis

A 5-year-old obese child with developmental delay, asthma, and obstructive sleep apnea presents for a tonsillectomy. Inhalation induction is begun. The airway is partially obstructed intermittently until nasopharyngeal and oral airways are inserted. On completion of surgery, pink, frothy fluid is noted in the endotracheal tube. A chest radiograph ( Fig. 201.1 ) is obtained, and the child is transferred to the intensive care unit for positive-pressure ventilation with positive end-expiratory pressure (PEEP). The following morning the chest radiograph is normal ( Fig. 201.2 ), and the child is extubated without incident.