Systematic Review of Negative Pressure Pulmonary Edema in Otolaryngology Procedures

Corina Din-Lovinescu, Usha Trivedi, Kathy Zhang, Gregory L. Barinsky, Jordon G. Grube, Jean Anderson Eloy, Wayne D. Hsueh

Research output: Contribution to journalArticlepeer-review


Objective(s): Negative pressure pulmonary edema (NPPE) is a rare perioperative complication with a potentially fatal outcome. The aim of this study was to perform a systematic review of NPPE in adult otolaryngology procedures with the goal of identifying risk factors, clinical presentation, diagnosis, management and outcomes. Methods: Systematic review performed using PubMed, Scopus, Web of Science, and Cochrane databases. Results: Sixty-nine studies including data from 87 individual patients were included in this review. Fifty-six (68%) patients were male and the average patient age was 37 years old. Type 1 NPPE occurred in 63 (72%) cases, while type 2 NPPE accounted for 20 (23%) cases. The most common procedures leading to NPPE were septoplasty, rhinoplasty or sinus surgery (n = 22, 25%), directly laryngoscopy or bronchoscopy (n = 13, 15%), and tracheostomy or cricothyroidotomy (n = 11, 13%). The most employed treatment options included diuretics (n = 55, 63%) and mechanical ventilation (n = 54, 62%). Seventy-eight (90%) patients made a full recovery with an average time to NPPE resolution of 33 hours and an average length of hospitalization of 5.6 days. Five (6%) patients had a long-term morbidity and four (5%) patients died, with age and ICU stay increasing risk for death and long-term morbidity (OR 1.044 and 7.42, respectively, P <.05). Conclusion: Septoplasty, rhinoplasty and sinus surgery account for the majority of NPPE cases in adult otolaryngology procedures. Young, healthy patients are the most commonly involved with a slight male predominance. The vast majority of patients recover fully, however there is a significant risk for morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)245-253
Number of pages9
JournalAnnals of Otology, Rhinology and Laryngology
Issue number3
StatePublished - Mar 2021

All Science Journal Classification (ASJC) codes

  • Otorhinolaryngology


  • negative pressure pulmonary edema
  • otolaryngology procedures
  • systematic review


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