Dear Editor,
This is with reference to the case report titled ‘Pulmonary oedema in a survivor of suicidal hanging’ (MJAFI 2004;60:188–189). The authors need to be complimented for quality critical care work in a peripheral hospital, however certain points need clarification.
I agree with authors that a post-obstructive pulmonary oedema is a form of non-cardiogenic pulmonary oedema, but in the case described it does not appear to be the underlying cause. This patient was rescued and first taken to Station Medicare Centre then to hospital. For sometime she was unconscious and airway was unprotected. The possibility of aspirtation can not be ruled out. Post-obstructive pulmonary oedema clears off within few hours of relief of upper airway obstruction and does not require prolong ventilatory treatment. Therefore, it seems more likely to be a case of aspiration pneumonitis. Following attempted suicide there is sudden loss of consciousness due to cerebral hypoxia, which can induce vomiting and subsequent aspiration of gastric contents. Aspiration pneumonitis can produce fulminant pulmonary oedema immediately because of acidic nature of gastric contents. Later it can progress to acute lung injury, severity of which depends upon quantity and quality of gastric aspirate. Radiological findings of bilateral non-homogenous opacities persisting for almost a week is also suggestive of acute lung injury as a consequence of aspiration pneumonitis. However the diagnosis of acute lung injury could not be confirmed due to non-availability of blood gas analyzer. In aspiration pneumonitis clinical picture does not correlate with radiological findings as observed by authors.
In the discussion, authors have not described as to what led them to suspect and treat this as a case of post-obstructive pulmonary oedema.