Case Report: Bronchoscopy-associated negative-pressure pulmonary edema in a child with severe

Objective: To describe the clinical features, underlying mechanisms, and treatment approaches for negative pressure pulmonary edema (NPPE) that develops after flexible bronchoscopy (FB) in children with severe Mycoplasma pneumoniae pneumonia (SMPP). Methods: We retrospectively reviewed the case of a pediatric patient with SMPP who had NPPE during FB. Results: During bronchoscopy, the patient began coughing violently. Soon after, when the bronchoscope was in place, the patient showed signs of diffuse airway spasm. The Forceful inspiration against a functionally blocked airway led to a sharp drop in intrathoracic pressure. It triggered acute NPPE, severe hypoxemia, and acute respiratory failure. There were also biochemical evidence of myocardial injury and transient cardiac dysfunction. After emergency intubation with a 4.5 mm endotracheal tube and the start of mechanical ventilation, oxygenation improved quickly. The pulmonary edema largely resolved within 72 h. The patient was discharged on day 16. Conclusion: Children with SMPP tend to have marked airway hyperresponsiveness. This makes them more likely to have airway obstruction during bronchoscopy. When a child suddenly develops hypoxemia, significant dyspnea, and pink frothy sputum, NPPE should be strongly suspected. Careful selection of surgical timing and anesthesia strategy, continuous respiratory monitoring, timely relief of airway obstruction, and early positive pressure ventilation are crucial. It is also important to prepare for a difficult airway.