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Li K, Wen L, Zhou H, Zhou Z. Massive hemoptysis in pregnancy treated by ECMO combined with electronic bronchoscopy: A case report. Heliyon 2024; 10:e23702. [PMID: 38187217 PMCID: PMC10767203 DOI: 10.1016/j.heliyon.2023.e23702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
Background Massive hemoptysis during pregnancy is very rare. Dieulafoy's disease is one of the causes of massive hemoptysis. There are few reports of ECMO use to treat massive hemoptysis during pregnancy. Findings We report for the first time a patient with Dieulafoy's disease diagnosed at 29 weeks of pregnancy. The patient's hemoptysis occurred rapidly with large volumes. The bleeding amount reached 500 ml within half an hour, with the development of asphyxia and respiratory and cardiac arrest due to a blood clot blocking the airway. After successful cardiopulmonary resuscitation, the ventilator could not maintain effective ventilation. Emergency establishment of VV-ECMO was performed to maintain oxygen, and hemostasis was successfully achieved by performing bronchial artery embolization twice. We successfully cleaned blood clots in the airway four times by freezing and using a foreign body retrieval basket with an electronic bronchoscope. At the same time, small and smooth nodular lesions were found under bronchoscopy, and blood vessels with a diameter of 1.5 mm were found under Doppler mode with an ultrasonic bronchoscope, which was consistent with a diagnosis of Dieulafoy's disease. VV-ECMO was successfully stopped on the 3rd day of the disease course, tracheal intubation was successfully removed on the 5th day of the disease course, and the patient was discharged with no complications on the 16th day of the disease course.
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Affiliation(s)
- Keyu Li
- Department of Respiratory and Critical Care Medicine, Changsha Hospital Affiliated to Xiangya School of Medicine, Central South University, Changsha, China
| | - Long Wen
- Department of Respiratory and Critical Care Medicine, Changsha Hospital Affiliated to Xiangya School of Medicine, Central South University, Changsha, China
| | - Haibo Zhou
- Department of Respiratory and Critical Care Medicine, Changsha Hospital Affiliated to Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhiguo Zhou
- Department of Respiratory and Critical Care Medicine, Changsha Hospital Affiliated to Xiangya School of Medicine, Central South University, Changsha, China
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Ziani H, Chibani A, Slaihi Z, Benhalima A, Armel B, ElHamzaoui H, Elazzouzi I, Eddouali A, Ghattab S, Elarfaoui M, Alilou M. Case report: Total obstruction of the left main bronchus by a blood clot leads to pneumonectomy in a pregnant woman. Ann Med Surg (Lond) 2024; 86:556-560. [PMID: 38222762 PMCID: PMC10783306 DOI: 10.1097/ms9.0000000000001527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/09/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction and importance Airway obstruction resulting from blood clot formation is observed across various clinical scenarios and is often preceded by hemoptysis. This condition can significantly compromise respiratory function, potentially leading to life-threatening ventilatory distress. Case presentation In this report, the authors present a case of acute airway obstruction associated with hemoptysis in an 18-week pregnant woman admitted to the emergency department for acute respiratory distress. Clinical and radiographic evidence strongly suggested the presence of an endobronchial blood clot causing focal airway obstruction. Diagnosis was confirmed through direct endoscopic evaluation. Clinical discussion Initial attempts to remove the obstructing clot from the airway involved lavage, aspiration, and forceps extraction by using a bronchoscope. In cases in which these measures proved ineffective, other management strategies include rigid bronchoscopy, embolization, and surgical resection. Conclusion Central airway obstruction is a critical condition caused by numerous factors such as tumours or blood clots. Treatment focuses on securing the airway, ensuring breathing, and using tools such as bronchoscopy for diagnosis and treatment. Surgery is considered a last resort when other methods are ineffective.
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Affiliation(s)
| | | | | | | | | | | | - Imane Elazzouzi
- Unit of Critical Emergency Care, Hospital IBN SINA, Rabat, Morocc
| | - Amine Eddouali
- Unit of Critical Emergency Care, Hospital IBN SINA, Rabat, Morocc
| | - Selma Ghattab
- Unit of Critical Emergency Care, Hospital IBN SINA, Rabat, Morocc
| | - Manal Elarfaoui
- Unit of Critical Emergency Care, Hospital IBN SINA, Rabat, Morocc
| | - Mustapha Alilou
- Unit of Critical Emergency Care, Hospital IBN SINA, Rabat, Morocc
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3
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Tamraz R, Austin R, Falcon R, Kraai T, Lock R, Petersen TR, Soneru C. Management of a Large Post-tonsillectomy Thrombus Obstructing the Laryngeal View: A Case Report. Cureus 2023; 15:e46763. [PMID: 37954797 PMCID: PMC10632186 DOI: 10.7759/cureus.46763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 11/14/2023] Open
Abstract
Anesthetic management of children with a post-tonsillectomy hemorrhage can be challenging. The patients may be anemic and hypovolemic and are at increased risk of having a difficult airway due to active bleeding, vomiting, and anatomical issues. A clot may also interfere with viewing the larynx, further exacerbating the difficulty of intubation. We describe a pediatric post-tonsillectomy hemorrhage case complicated by a large obstructing clot that was removed with Magill forceps after the airway was successfully secured with an endotracheal tube during rapid sequence induction.
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Affiliation(s)
- Rana Tamraz
- Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Roman Austin
- Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Ricardo Falcon
- Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Tania Kraai
- Otolaryngology - Head and Neck Surgery, University of New Mexico School of Medicine, Albuquerque, USA
| | - Richard Lock
- Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Timothy R Petersen
- Office of Graduate Medical Education, University of New Mexico School of Medicine, Albuquerque, USA
- Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Codruta Soneru
- Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, USA
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Lee UL, Jang HW, Choung HW, Lee SY, Choi YJ. A Novel Device for Blood Drainage after Le Fort I Osteotomy: Maxillary Sinus Ventilation Drainage (MSVD). J Clin Med 2022; 11:jcm11030562. [PMID: 35160014 PMCID: PMC8836406 DOI: 10.3390/jcm11030562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study is to present a novel maxillary sinus ventilation drainage (MSVD) device which facilitates blood drainage and nasal breathing after Le Fort I osteotomy. One hundred patients who underwent bimaxillary orthognathic surgery from January 2016 to June 2016 at the Department of Oral and Maxillofacial Surgery, Chung-Ang University Hospital were retrospectively selected and divided into two groups. MSVD was applied in 50 patients, who were allocated to the MSVD group, while the remaining 50 patients, in whom MSVD was not applied, were allocated to the non-MSVD group. All patients underwent a cone-beam computed tomography (CBCT) scan before and 2 days after surgery. CBCT was used to analyze middle meatus patency and the percentage of hematoma volume per entire maxillary sinus volume. Statistical comparisons between the two groups were performed using the Chi-squared and Mann–Whitney U tests to investigate the clinical effectiveness of MSVD. The MSVD group showed significantly higher maintenance ratio of the middle meatus patency and a higher percentage of maxillary sinus air volume (p < 0.05) than the non-MSVD group. MSVD facilitated nasal breathing after Le Fort I osteotomy by reducing hematoma inside the maxillary sinus and promoting middle meatal patency.
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Affiliation(s)
- Ui-Lyong Lee
- Department of Oral and Maxillofacial Surgery, Dental Center, Chung-Ang Hospital, Seoul 06973, Korea; (U.-L.L.); (H.-W.C.)
| | - Hyo-Won Jang
- Department of Oral and Maxillofacial Surgery, Yonsei Twins Dental Clinic, Seoul 07997, Korea;
| | - Han-Wool Choung
- Department of Oral and Maxillofacial Surgery, Dental Center, Chung-Ang Hospital, Seoul 06973, Korea; (U.-L.L.); (H.-W.C.)
| | - Sei-Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University, Seoul 06973, Korea;
| | - Young-Jun Choi
- Department of Oral and Maxillofacial Surgery, College of Medicine, Chung-Ang University, Seoul 06973, Korea
- Correspondence: ; Tel.: +82-2-6299-2880
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Watanabe K, Oka S, Kai T, Hoshino K, Nakamura J, Abe M, Watanabe A. Tracheobronchial Obstruction Due to Blood Clots in Acute Pulmonary Embolism with Cardiac Arrest Managed with Extracorporeal Membrane Oxygenation. Intern Med 2021; 60:2811-2817. [PMID: 33716289 PMCID: PMC8479226 DOI: 10.2169/internalmedicine.6856-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A 66-year-old Japanese woman developed pulseless electrical activity following an acute pulmonary embolism and was treated with thrombolytic therapy. She remained hemodynamically unstable and therefore underwent extracorporeal membrane oxygenation (ECMO). While receiving treatment with ECMO, blood clots induced by endobronchial hemorrhage caused tracheobronchial airway obstruction, leading to ventilatory defect. Furthermore, her cardiac function improved, resulting in cerebral hypoxemia progression. Therefore, the blood clots were removed with a Fogarty balloon catheter and endobronchial urokinase administration, resulting in improvement in her respiratory condition. Finally, ECMO was decannulated, and the patient was discharged from our hospital without difficulties in her activities of daily living.
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Affiliation(s)
| | - Satoshi Oka
- Department of Cardiology, Fujieda Municipal General Hospital, Japan
| | - Takahiko Kai
- Department of Cardiology, Fujieda Municipal General Hospital, Japan
| | - Katsuomi Hoshino
- Department of Cardiology, Fujieda Municipal General Hospital, Japan
| | - Jun Nakamura
- Department of Cardiology, Fujieda Municipal General Hospital, Japan
| | - Makoto Abe
- Department of Cardiology, Fujieda Municipal General Hospital, Japan
| | - Akinori Watanabe
- Department of Cardiology, Fujieda Municipal General Hospital, Japan
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Munakata H, Higashi M, Tamura T, Adachi YU. Fatal airway obstruction due to a ball-valve clot with identical signs of tension pneumothorax. Acute Crit Care 2021; 35:298-301. [PMID: 33423441 PMCID: PMC7808852 DOI: 10.4266/acc.2019.00570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 11/01/2019] [Indexed: 12/02/2022] Open
Abstract
Endo-tracheal tube obstruction due to an extensive blood clot is a recognized but very rare complication. A ball-valve obstruction in the airway could function as a check valve for the lung and thorax, resulting in tension pneumothorax-like abnormalities. A 47-year-old female patient had undergone implantation of a left ventricular assist device 3 weeks prior. On post-operative day 17, planned thoracentesis was performed for drainage of a pleural effusion. Despite the drainage, the patient’s oxygenation did not improve, and emergency tracheal intubation was conducted. Subsequent computed tomography revealed bilateral pneumothorax. Two days later, the patient’s trachea was extubated without complication, and a mini-tracheostomy tube was placed. Three hours later, reintubation was conducted due to progressive tachypnea. Although successful intubation was confirmed, ventilation became increasingly difficult and finally impossible. Marked increase in pulmonary artery and central venous pressures suggested progression of the previous tension pneumothorax. After emergency extracorporeal membrane oxygenation was initiated, fiberoptic bronchoscopy revealed the presence of a massive clot and ball-valve obstruction of the endotracheal tube. Two weeks later, the patient died due to severe hypoxic brain damage. Diagnosis of ball valve clot is not simple, but intensivists should consider this rare complication.
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Affiliation(s)
- Hisaaki Munakata
- Department of Surgical Intensive Care Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Michiko Higashi
- Department of Emergency and Medical Intensive Care Unit, Nagoya University Hospital, Nagoya, Japan
| | - Takahiro Tamura
- Department of Surgical Intensive Care Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Yushi Ueda Adachi
- Department of Surgical Intensive Care Medicine, Nagoya University Hospital, Nagoya, Japan
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Schmidt LH, Schulze AB, Goerlich D, Schliemann C, Kessler T, Rottmann V, den Toom D, Rosenow F, Sackarnd J, Evers G, Mohr M. Blood clot removal by cryoextraction in critically ill patients with pulmonary hemorrhage. J Thorac Dis 2019; 11:4319-4327. [PMID: 31737317 DOI: 10.21037/jtd.2019.09.46] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Severe pulmonary hemorrhage is a life-threatening complication in critically ill patients. Due to tracheobronchial obstruction, ventilation is often impaired. Traditionally, rigid bronchoscopy is an option for recanalization. However, in comparison to flexible bronchoscopy, the application of rigid bronchoscopy is more complex. Against this background we evaluated the use of flexible cryo-probes for blood clot removal in critically ill patients. Methods Retrospectively, we identified 16 patients (median age: 60 years, 69% male patients), who suffered from severe airway obstruction due to blood clots. All patients required invasive ventilation and 11 patients depended on extracorporeal membrane oxygenation (ECMO). To remove blood clots, flexible bronchoscopic cryoextraction was performed in n=27 cases, whereas rigid bronchoscopy was only needed in two cases. Results Whereas in 9 cases single flexible cryoextraction was successful immediately, the procedure had to be repeated again in 7 patients. In all cases, tracheobronchial obstruction was treated with success and conditions of invasive ventilation were improved. In no case severe complications were observed. Conclusions In consideration of the underlying evaluation, we highly recommend flexible cryoextraction as both a safe and less complex technique for blood clot removal in critically ill patients.
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Affiliation(s)
- Lars Henning Schmidt
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Dennis Goerlich
- Institute of Biostatistics and Clinical Research, Westfaelische Wilhelms-Universitaet Muenster, Muenster, Germany
| | - Christoph Schliemann
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Torsten Kessler
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Veronika Rottmann
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Daniel den Toom
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Felix Rosenow
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Muenster, Muenster, Germany
| | - Jan Sackarnd
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Muenster, Muenster, Germany
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
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Lehnus K. Endotracheal tube obstruction with a blood clot following aspiration of rumen contents in a reindeer. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2018-000641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
SummaryAn apparently otherwise healthy female reindeer was anaesthetised for open reduction and fixation of a hip luxation. The animal developed ruminal bloat which was treated with passage of an orogastric tube that was left indwelling during the procedure. A fluid inspiratory noise was audible two hours after decompression, and clear fluid was suctioned from the airway. It showed no other signs of regurgitation and aspiration of rumen contents intraoperatively, and did not develop obvious respiratory compromise while mechanically ventilated. In recovery, the deer became apnoeic and cyanotic and died suddenly within minutes of being positioned in the recovery box. Just before dying, it coughed a large blood clot out of the endotracheal tube (ETT) . Additional clots were found partially obstructing the ETT lumen once extubated postmortem. Evidence of aspiration was detected at postmortem examination, which also identified pulmonary haemorrhage.
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Saladi L, Lvovsky D. Organized blood clot masquerading as endobronchial tumor: A review of management and recent advances. Respir Med Case Rep 2018; 24:165-169. [PMID: 29977787 PMCID: PMC6010643 DOI: 10.1016/j.rmcr.2018.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 01/01/2023] Open
Abstract
Central airway obstruction, a frequently encountered emergency, is usually associated with blood clots, tumors, foreign bodies or mucus plugs. Airway obstruction due to blood clots can be seen as a complication of lung malignancies, infections, bronchiectasis, arteriovenous malformations or pulmonary infarction. In patients with long standing blood clots, the thrombus gets organized and firmly adherent to the airway. The diagnosis is often misleading as these clots mimic tumors clinically and on imaging. Hemoptysis is the most common presenting symptom though many patients can be asymptomatic. Direct visualization with bronchoscopy is required to establish a diagnosis. Life-threatening respiratory impairment is an indication for emergent clot retrieval. Management of these blood clots, especially when organized, is challenging. Initial attempts at removal should include suctioning, lavage or forceps extraction. When unsuccessful, further management options include balloon catheter dislodgement, use of topical thrombolytics, rigid bronchoscopy and cryoextraction.
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Affiliation(s)
- Lakshmi Saladi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Care Health System, 1650 Grand Concourse, Bronx, NY 10457, USA
- Corresponding author.
| | - Dmitry Lvovsky
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Care Health System, 1650 Grand Concourse, Bronx, NY 10457, USA
- Icahn School of Medicine at Mount Sinai, USA
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Soler X, Mahmoud M, Smith G, Subramanyam R. Not all mucous plugs are created equal! J Clin Anesth 2017; 37:129. [PMID: 28235501 DOI: 10.1016/j.jclinane.2016.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 12/10/2016] [Accepted: 12/16/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Ximena Soler
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH, USA
| | - Mohamed Mahmoud
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH, USA
| | - Gregory Smith
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH, USA
| | - Rajeev Subramanyam
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH, USA.
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Abstract
BACKGROUND Intensive care unit (ICU) stays are 2.5 times more costly than other hospital stays, and 93.3% of ICU use is for respiratory disease with ventilator support. The aim of this study was to assess the role of bronchoscopy on discontinuation of mechanical ventilation, and prompt discharge from ICU in our institution. METHODS Retrospective review of medical records of patients referred for bronchoscopic intervention for acute respiratory failure from malignant or benign central airway diseases requiring ICU admission. RESULTS Twelve critically ill patients were studied. Median (range) age was 63 years (range, 35 to 85 y). Nine (75%) had endotracheal tube, and 3 (25%) had tracheostomy tube. Nine (75%) of 12 patients admitted to ICU could be transferred to general ward after median (range) interval of 2 days (range, 1 to 7 d) after the day of intervention. Median (range) prebronchoscopy and postbronchoscopy PaO2/FiO2 ratio was 102.8 (range, 99.2 to 328) and 180 (range, 129 to 380), respectively, with significant improvement postintervention (P=0.002). Radiologically, all 8 patients with lung atelectasis on presentation experienced complete reexpansion of the lung on the day after bronchoscopic intervention. CONCLUSION The majority of patients in our cohort (75%) of benign and malignant etiology could be promptly (within 2 d postbronchoscopy) transferred out from ICU to general ward after successful discontinuation of mechanical ventilation and extubation after bronchoscopic intervention. We advocate early recognition and bronchoscopic intervention in suitable patients.
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Complete Obstruction of Endotracheal Tube in an Infant with a Retropharyngeal and Anterior Mediastinal Abscess. Case Rep Pediatr 2017; 2017:1848945. [PMID: 28299222 PMCID: PMC5337372 DOI: 10.1155/2017/1848945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/12/2017] [Indexed: 11/29/2022] Open
Abstract
Intraoperative ventilatory failure is not an uncommon complication; however, acute endotracheal obstruction by a foreign body or blood clot can be difficult to quickly discriminate from other causes. Once the diagnosis is made, quick action is needed to restore ventilation. The ultimate solution is to exchange the endotracheal tube; however, there can be other ways of resolving this in situations where reintubation would be difficult or unsafe. This case report discusses such an event in an infant with multiple airway challenges including a retropharyngeal and anterior mediastinal abscess. We have also formulated a pathway based on various case reports involving complete ETT obstruction.
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Tenda ED, Yakub A, Pitoyo CW, Fardizza F. Combination of bronchoscopic cryoextraction and argon plasma coagulation in treatment of total central airway obstruction caused by giant blood clot formation in massive airway bleeding. Respir Med Case Rep 2016; 19:9-11. [PMID: 27330965 PMCID: PMC4913173 DOI: 10.1016/j.rmcr.2016.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 06/06/2016] [Accepted: 06/10/2016] [Indexed: 11/24/2022] Open
Abstract
Life threatening event due to central airway obstruction caused by very large blood clot formation with profuse on going bleeding its very challenging to manage. Interventional pulmonologist must aware about this situation which can lead to respiratory failure. There are several choices to treat this unlikely situation, in example flexible bronchoscopy with forceps, bronchial lavage, and suction. We present a case with post-surgical tracheostomy bleeding which caused a giant blood clot formation in a disseminated intravascular coagulation due to severe sepsis in end stage renal disease patient, successfully managed with cryoextraction and argon plasma coagulation. Combinations of two endobronchial approaches can give a quick, safe and cost effective lifesaving treatment.
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Affiliation(s)
- Eric Daniel Tenda
- Division of Respirology and Critical Care, Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Abraham Yakub
- Division of Respirology and Critical Care, Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ceva Wicaksono Pitoyo
- Division of Respirology and Critical Care, Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Fauziah Fardizza
- Department of Otorhinolaryngology, Head and Neck Surgery, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Liberman JS, Weigel W, Neal JM. Difficult Ventilation After Successful Intubation in the Emergency Setting due to a Ball Valve Clot. A & A CASE REPORTS 2016; 6:291-2. [PMID: 26934604 DOI: 10.1213/xaa.0000000000000294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The inability to ventilate a patient after successful intubation is a rare but emergent situation and may be caused by obstruction of the endotracheal tube, bilateral tension pneumothorax, esophageal intubation, severe bronchospasm, or mainstem bronchus intubation. We describe an increase in mean airway pressure, inability to ventilate, and loss of cardiac output secondary to a blood clot acting as a ball valve at the end of an endotracheal tube.
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Affiliation(s)
- Justin S Liberman
- From the Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington
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15
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Papo M, Crockett F, Gounant V, Assouad J, Schlemmer F, Bergeron A, Antoine M, Naccache JM. Cystic Pulmonary Myxoid Liposarcoma Mimicking Endobronchial Blood Clot. J Bronchology Interv Pulmonol 2016; 23:152-4. [PMID: 27058719 DOI: 10.1097/lbr.0000000000000188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 71-year-old-man was transferred to our hospital in November 2012 for a bronchial artery embolization in the context of recurrent blood clots obstructing the left lower bronchus. Since June 2012, he had been explored for a cystic hypermetabolic lesion of the entire left lobe, and underwent 3 bronchoscopies and 2 computed tomography scan-guided biopsies, with no success. A fourth bronchoscopy enabled the extraction of a large blood clot (8×1.5 cm) that obstructed the left main bronchus. The pathologic examination of the mucosal biopsy samples was inconclusive, whereas the cytologic examination of the blood clot revealed myxoid liposarcoma. Liposarcomas are the most common histologic types of soft-tissue sarcomas. They preferentially metastasize to the lungs and can appear as cystic mass. Bronchial obstruction by blood clots is not a rare finding on bronchoscopy, their main problem is their removal which could require rigid bronchoscope and large forceps. However, bronchial blood clot containing tumoral process had never been reported before. In conclusion, this case conveys 2 messages. First, pulmonary metastasis of myxoid liposarcoma can appear as cyst secondary to endobronchial tumoral growth. Second, endobronchial blood clots should always be sent for pathologic analysis.
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Affiliation(s)
- Matthias Papo
- *Service de Pneumologie †Service de Chirurgie Thoracique §Service d'anatomo-pathologie, Hôpital Tenon, Université Pierre et Marie Curie ‡Service de Pneumologie, Hôpital Saint-Louis, Université Denis Diderot, Assistance Publique-Hôpitaux de Paris, Paris, France
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Liu PH, Chen YT, Chen WH, Shih YH, Hung KC. Acute Airway Obstruction in the Nonoperated Lung Following Intravenous Administration of Tranexamic Acid During Pneumonectomy. J Cardiothorac Vasc Anesth 2016; 30:459-61. [DOI: 10.1053/j.jvca.2015.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Indexed: 11/11/2022]
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Abstract
Adult or postprimary tuberculosis (TB) accounts for most TB cases. Its hallmark is pulmonary cavitation, which occurs as a result of necrosis in the lung in individuals with tuberculous pneumonia. Postprimary TB has previously been known to be associated with vascular thrombosis and delayed-type hypersensitivity, but their roles in pulmonary cavitation are unclear. A necrosis-associated extracellular cluster (NEC) refers to a cluster of drug-tolerant Mycobacterium tuberculosis attached to lysed host materials and is proposed to contribute to granulomatous TB. Here we suggest that NECs, perhaps due to big size, produce a distinct host response leading to postprimary TB. We propose that vascular thrombosis and pneumonia arise from NEC and that these processes are promoted by inflammatory cytokines produced from cell-mediated delayed-type hypersensitivity, such as interleukin-17 and gamma interferon, eventually triggering necrosis in the lung and causing cavitation. According to this view, targeting NEC represents a necessary strategy to control adult TB.
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Safety and Clinical Utility of Flexible Bronchoscopic Cryoextraction in Patients With Non-neoplasm Tracheobronchial Obstruction. J Bronchology Interv Pulmonol 2015; 22:288-93. [DOI: 10.1097/lbr.0000000000000203] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Woittiez KJ, Woittiez AJJ. Fatal endotracheal tube obstruction due to the ball valve effect. BMJ Case Rep 2015; 2015:bcr-2014-208189. [PMID: 25618886 DOI: 10.1136/bcr-2014-208189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In patients suffering from pulmonary haemorrhage, or in patients who recently received a tracheostomy, acute occlusion of the endotracheal tube due to a blood clot is a rare, but well-known complication. Acute and complete occlusion of the tube is easily recognisable. There are various methods of removing the obstructive clot, such as using a bronchoscope with forceps, topical thrombolysis, saline lavage and suctioning. There are no guidelines concerning preventive routine bronchoscopic lavage. When there is a partial obstruction of the endotracheal tube, ventilation is possible, although high inspiratory pressures are necessary. If the clot functions as a ball valve ventil, raised intrathoracic pressure will cause right-sided heart failure or tension pneumothorax. It is important to recognise a partially obstructed tube in time and remove the obstruction.
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20
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Küls N, Murison PJ. Partial endotracheal tube obstruction by a blood clot in two dogs. VETERINARY RECORD CASE REPORTS 2015. [DOI: 10.1136/vetreccr-2015-000203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nina Küls
- Anaesthesia and Perioperative Intensive CareVeterinary University of ViennaViennaAustria
| | - Pamela J Murison
- Royal (Dick) School of Veterinary StudiesThe University of EdinburghEdinburghUK
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21
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Lloyd D, Bomford J, Barry M, Berry W, Barrett N, Camporota L, Ioannou N, Lams B, Langrish C, Meadows C, Retter A, Wyncoll D, Glover G. Endobronchial streptokinase for airway thrombus: a case series. Crit Care 2015. [PMCID: PMC4472801 DOI: 10.1186/cc14291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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22
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Lee H, Leem CS, Lee JH, Lee CT, Cho YJ. Successful removal of endobronchial blood clots using bronchoscopic cryotherapy at bedside in the intensive care unit. Tuberc Respir Dis (Seoul) 2014; 77:193-6. [PMID: 25368667 PMCID: PMC4217037 DOI: 10.4046/trd.2014.77.4.193] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/10/2014] [Accepted: 06/25/2014] [Indexed: 11/28/2022] Open
Abstract
Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These conditions may result in life-threatening ventilation impairment. We report a case of obstruction of the large airway by endobronchial blood clots which were removed using bronchoscopic cryotherapy at the bedside of intensive care unit. A 66-year-old female with endometrial cancer who had undergone chemotherapy, was admitted to the intensive care unit due to neutropenic fever. During mechanical ventilation, the minute ventilation dropped to inadequately low levels and chest radiography showed complete opacification of the left hemithorax. Flexible bronchoscopy revealed large blood clots obstructing the proximal left main bronchus. After unsuccessful attempts to remove the clots with bronchial lavage and forceps extraction, blood clots were removed using bronchoscopic cryotherapy. This report shows that cryotherapy via flexible bronchoscopy at the bedside in the intensive of intensive care unit is a simple and effective alternative for the removal of endobronchial blood clots.
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Affiliation(s)
- Hongyeul Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cho Sun Leem
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Choon-Taek Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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23
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Parrott R, Hong SJ, Greenberg M. Family history unawareness of blood clot risk: links to misdiagnoses and illness uncertainties in personal and expert realms. JOURNAL OF HEALTH COMMUNICATION 2014; 20:35-42. [PMID: 24794077 DOI: 10.1080/10810730.2014.901443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The difficulty of diagnosing blood clots makes salient the question, "What role does family history awareness have for guiding lay and expert actions?" The authors examine the in-depth life reflection interviews of 20 women who experienced a first venous blood clot between the ages of 18 and 50 years, identifying causal attributions the women made for thrombosis after the event. Twelve participants described an understanding of the cascade of events linked to thrombosis, revealing that there is seldom a single cause. The other eight identified belief in a single determining cause for their thrombosis. The authors reflect on the symptoms the women experienced during the course of the clotting event, patterns of care that they executed to self-manage their blood clot, and their misdiagnoses associated with symptoms and care. The women recalled the patterns of care received through formal health care systems and the reported misdiagnoses linked to these interactions. The recollections reveal that the subtle nature of venous blood clot symptoms contributes to lay and expert misdiagnoses. Use of antibiotics and pain killers in the wake of misdiagnosis masks symptoms, contributing to costly delays in accurate diagnoses. Four women were aware of a family history of clotting when the event occurred, 13 had such a history but lacked awareness until the clotting event, and three had no known history. Among women with awareness of their family history, blood clot diagnosis occurred sooner, promoting survival and efficiencies in health care. Implications for communicating about family history of thrombosis are considered.
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Affiliation(s)
- Roxanne Parrott
- a Department of Communication Arts & Sciences , The Pennsylvania State University , University Park , Pennsylvania , USA
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24
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Kenth J, Ng C. Foreign body airway obstruction causing a ball valve effect. JRSM SHORT REPORTS 2013; 4:2042533313482458. [PMID: 23885292 PMCID: PMC3697858 DOI: 10.1177/2042533313482458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Johnny Kenth
- Chase Farm Hospital, Enfield, Middlesex EN2 8JL, UK
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25
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26
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Lim HK, Lee MH, Shim HY, Byon HJ, Ahn HS. Complete obstruction of an endotracheal tube due to an unexpected blood clot in a patient with a hemo-pneumothorax after repositioning of the patient for lumbar spine surgery. Korean J Anesthesiol 2013; 64:382-3. [PMID: 23646253 PMCID: PMC3640176 DOI: 10.4097/kjae.2013.64.4.382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Hyun Kyoung Lim
- Department of Anesthesiology and Pain Medecine, Inha University Hospital, Incheon, Korea
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27
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Gupta A, Kishor, Thakur VK, Kumar A. Sudden endotracheal tube block in a patient of Achalasia Cardia. J Anaesthesiol Clin Pharmacol 2012; 28:381-3. [PMID: 22869952 PMCID: PMC3409955 DOI: 10.4103/0970-9185.98353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Endotracheal tube block due to various mechanical causes such as mucous, blood clot, denture, and ampoules have been reported. A patient of achalasia cardia with chronic passive aspiration pneumonitis developed mucoid mass in the respiratory passage which dislodged during the surgical procedure. The episode occurred almost an hour after induction of anesthesia and the dislodged mucoid mass blocked the lumen of endotracheal tube, leading to hypoxia and impending cardiac arrest. However, the patient was salvaged by replacing the tube.
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Affiliation(s)
- Ajit Gupta
- Department of Anesthesiology and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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28
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CRITICAL CARE. Br J Anaesth 2012. [DOI: 10.1093/bja/aer477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Westbrook BJ, Wilhelm M, Shvidler J. Novel use of a suction-irrigation device to remove impacted blood clot from the airway. Ann Otol Rhinol Laryngol 2012; 121:13-5. [PMID: 22312922 DOI: 10.1177/000348941212100103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We sought to describe the novel use of a suction-irrigation device to remove a large blood clot that was causing critical obstruction of the trachea and main stem bronchi in our patient. METHODS A large-bore suction-irrigation device designed for use in gynecologic cases was adapted for use in removal of an obstructing blood clot in the face of patient decompensation after several unsuccessful attempts at removal with standard otolaryngological instruments. RESULTS The tracheal obstruction and the significant bronchial obstructions were successfully removed with the suction-irrigation device. The patient's ventilatory status quickly stabilized. He was extubated the following day and discharged home. CONCLUSIONS The suction-irrigation device proved highly successful in removing a large blood clot from the airway. A similarly designed device made specifically for the airway could prove useful in similar cases in the future.
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Affiliation(s)
- Benjamin J Westbrook
- Department of Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA
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30
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Separation from Cardiopulmonary Bypass with a Rigid Bronchoscope Airway After Hemoptysis and Bronchial Impaction with Clot. Anesth Analg 2012; 114:89-92. [DOI: 10.1213/ane.0b013e318237f692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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31
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Phillips T, Bailes I, Golden B. Blood clot causing airway obstruction and the use of jet ventilation. Anaesthesia 2011; 66:626-7. [PMID: 21682711 DOI: 10.1111/j.1365-2044.2011.06739.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Sisu RC, Bicescu G, Vinereanu D. Massive atelectasis with acute respiratory failure in postpartum misdiagnosed as pulmonary embolism. Am J Emerg Med 2010; 28:842.e1-4. [PMID: 20837267 DOI: 10.1016/j.ajem.2009.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 11/07/2009] [Indexed: 11/18/2022] Open
Affiliation(s)
- Roxana C Sisu
- Department of Cardiology, University and Emergency Hospital of Bucharest, 169 Splaiul Independentei, sector 5, 050098, Bucharest, Romania
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33
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Cho WK, Rubinowitz AN, Siegel MD. Endobronchial blood clots causing unilateral atelectasis with near asphyxiation. CLINICAL RESPIRATORY JOURNAL 2010; 3:112-3. [PMID: 20298387 DOI: 10.1111/j.1752-699x.2008.00069.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Won-Kyung Cho
- Pulmonary and Critical Care Section, Department of Medicine, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT 06520, USA
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34
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Söllmann C, Trautner H, Papenfuss T, Lange M, Roewer N. [Tension pneumothorax after acute airway displacement due to pulmonary aspergillosis]. Anaesthesist 2009; 58:602-6. [PMID: 19562397 DOI: 10.1007/s00101-009-1558-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Acute lymphoblastic leukaemia is the most common malignancy in childhood. This disease and its associated therapy may lead to specific life-threatening complications if general anaesthesia has to be carried out. The case of a 14-year-old boy suffering from aspergillosis because of immunosuppression in the course of chemotherapy is reported. Due to a cerebral round lesion an open biopsy was required. After induction of anaesthesia, severe pulmonary obstruction developed. After exchange of the endotracheal tube a coagulum-like foreign body interspersed with Aspergillus hyphae obstructing the distal aperture in a valve-like manner could be recovered. The resulting unilateral tension pneumothorax had to be relieved with a closed pleural drainage. With reference to this as yet unreported life-threatening complication of pulmonary aspergillosis, the appropriate preparation and conduction of general anaesthesia are discussed.
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Affiliation(s)
- C Söllmann
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinik Würzburg, Würzburg, Deutschland.
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35
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Tracheobronchial thrombus: management of a life-threatening complication of central venous catheterization. Eur J Anaesthesiol 2009; 26:355-7. [PMID: 19276916 DOI: 10.1097/eja.0b013e3283262c70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Bresci F, Di Paolo M, Martelli M, De Simone L, Giunta F, Ambrosino N. A fatal case of airway obstruction by an organic one-way valve. Chron Respir Dis 2009; 6:47-8. [PMID: 19176713 DOI: 10.1177/1479972308098667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a fatal case of airway obstruction. A tracheostomized, spontaneously breathing 39-year-old man developed dyspnea, cardiac, and respiratory arrest after tracheal cannula replacement. Inspection of the cannula showed a blood clot obstructing the tube. Autopsy showed pink foam in the trachea, pulmonary hyperinflation, and congested lung parenchyma. Histological examination showed acute pulmonary emphysema without any sign of blood inhalation. The probable pathophysiological mechanism is a clot creating a one-way valve allowing inspiration but not expiration, resulting in dyspnea and pulmonary hyperinflation.
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Affiliation(s)
- F Bresci
- Department of Neurosciences, Institute of Legal Medicine, University of Pisa, and Intensive Care Unit, Department of Surgery, University Hospital, Pisa, Italy
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37
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Fitzwater KL, Marks SL, Hanel RM. Thrombi in the trachea of a dog secondary to placement of a tracheotomy tube. J Am Vet Med Assoc 2008; 233:758-60. [DOI: 10.2460/javma.233.5.758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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38
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Pazanin L, Misak VB, Goreta N, Mareković Z, Petrovecki V. Iatrogenic tracheal laceration causing asphyxia. J Forensic Sci 2008; 53:1185-7. [PMID: 18643864 DOI: 10.1111/j.1556-4029.2008.00827.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Endotracheal intubation is a simple, rapid, and safe technique that is being used as a standard procedure for airway management. However, airway injury during endotracheal intubation could be a significant source of morbidity or even mortality for patients and a source of liability for physicians as well. We report an unusual case of fatal tracheal occlusion by intraluminal blood clot complicating endotracheal intubation. The patient, a 62-year-old woman, with renovascular hypertension and incipient renal failure was scheduled for renal autotransplantation. The surgery was uneventful but the postoperative course was complicated with a lethal airway obstruction. At autopsy a linear longitudinal tracheal laceration was identified with an intraluminal blood clot obstructing the tracheal lumen. Tracheal laceration as a cause of death is a rare and potentially fatal complication of endotracheal intubation with intratracheal bleeding, clot formation, tracheal occlusion, and subsequent asphyxia.
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Affiliation(s)
- Leo Pazanin
- Department of Neuropathology, Clinical Hospital Center Zagreb, Zagreb, Croatia.
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39
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Huang ST, Kuo CP, Chen JC, Wu CT, Hsieh CM, Wong CS, Yeh CC. Successful cardiopulmonary resuscitation in a morbidly obese patient with airway obstruction 10 days after tracheostomy. ACTA ANAESTHESIOLOGICA TAIWANICA : OFFICIAL JOURNAL OF THE TAIWAN SOCIETY OF ANESTHESIOLOGISTS 2008; 46:30-33. [PMID: 18390398 DOI: 10.1016/s1875-4597(08)60017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Tracheostomy is often performed in patients requiring prolonged ventilatory support. Tracheostomy tube obstruction caused either by blood clots, mucous plugs, tube malposition and tissue granulation can lead to life-threatening complications. The risk of such complications is markedly increased in morbidly obese individuals. Here we report an incident in an 81-year-old, morbidly obese, male patient who sustained airway obstruction which resulted in cardiac arrest 10 days after tracheostomy. A 17-cm 10-ng blood clot in a tracheobronchial configuration was found to cause the obstruction. It was removed and the patient recovered after resuscitation. The etiology of the obstruction, specific management, and recommendations are discussed.
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Affiliation(s)
- Shun-Tsung Huang
- Division of Anesthesiology, Taichung Armed Forces General Hospital, Taichung, Taiwan, R.O.C
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40
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Abstract
Acute occlusion of an endotracheal tube (ETT) is a feared, potentially life-threatening complication of mechanical ventilation. In the presence of a thoracic trauma, a blood clot needs to be taken into consideration as the cause of airway obstruction. This report describes a case of sudden ventilation failure due to acute ETT obstruction by a blood clot caused by intrapulmonary haemorrhaging in a child following multiple trauma accompanied by blunt thoracic trauma in the absence of dyspnoe or haemoptysis.
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41
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Bae JY, Woo CH, Yang MS, Mun SH, Kwak IS, Kim KM. Hemoptysis and obstruction of the endotracheal tube by blood clot in a pediatric patient - A case report -. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.55.2.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ji Young Bae
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Chul-Ho Woo
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Min-seok Yang
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Sung Ha Mun
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, College of Medicine, Sungkyunkwan University, Seoul, Korea
| | - In-Suk Kwak
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Kwang-min Kim
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
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42
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Alptekin B, Tran DT, Lisbon A, Kaynar AM. Bedside ultrasonography in the differential diagnosis of pulmonary pathologies in the intensive care unit. J Clin Anesth 2007; 18:534-6. [PMID: 17126784 DOI: 10.1016/j.jclinane.2006.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 03/22/2006] [Accepted: 03/22/2006] [Indexed: 11/19/2022]
Abstract
Among critically ill patients, opacification of a part or whole lung field on chest radiography may pose a challenge in the differential diagnosis of acute pulmonary pathologies (eg, pneumothorax, hemothorax, pleural effusion, atelectasis, and solid organ in thoracic cavity) and selection of treatment modalities. In cases in which clinical findings, history, and imaging studies are not conclusive, bedside ultrasonography may be invaluable in achieving a diagnosis. We present two cases in which portable ultrasonography at the bedside was critical to the diagnosis and subsequent management of the patient.
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Affiliation(s)
- Burak Alptekin
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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43
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Abstract
Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year, for a combined mortality of 48 deaths per 100,000 population per year. Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals. Preventability of trauma deaths has been reported as high as 76% and as low as 1% in mature trauma systems. Critical care errors may occur in a half of hospital trauma deaths, in most of the cases contributing to the death. The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions. A systematic approach to the trauma patient in the critical care unit would avoid errors and preventable deaths.
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Affiliation(s)
- Alberto Garcia
- Trauma Division, Hospital Universitario del Valle, Calle 5 No. 36-08, Cali, Columbia.
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44
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Abstract
Asphyxia secondary to airway obstruction has numerous underlying causes, both acute and chronic. Causes of chronic airway obstruction, such as neoplasms and tracheal scarring, are often clinically apparent well prior to asphyxia. Causes of acute airway obstruction may not be as obvious to clinicians or investigators. These include infections, anaphylactic reactions, status asthmaticus, inhalational injuries, and aspirations, which may result in acute obstruction and sudden death. We report the deaths of 2 individuals, a 43-year-old female and a 78-year-old female, both with adenocarcinoma. The 43-year-old was hospitalized with a stage III, poorly differentiated infiltrating ductal carcinoma of the breast metastatic to the lymph nodes. She was intubated to treat poor respiratory function and acidosis. A bronchoalveolar lavage was consistent with alveolar hemorrhage; no organisms were identified. Blood and "clot" were in her endotracheal tube, so the endotracheal tube was replaced. She became comatose and life support was withdrawn. At autopsy, a large red-gray thrombus obstructed the trachea and extended into the right bronchus. Microscopically, the entire clot was composed of fibrin, red blood cells, and some mucus. Findings of acute respiratory distress syndrome with hyaline membranes were identified. The cause of death was listed as acute respiratory distress syndrome with tracheobronchial thrombus. Experiencing a decline in mental status, the 78-year-old had metastatic adenocarcinoma of unknown primary. She developed sudden respiratory distress and an airway obstruction was discovered. After failure to relieve the obstruction, she decompensated and died. At autopsy, a large, red-gray thrombus obstructed the distal trachea and both bronchi. Microscopically, the thrombus was composed of fibrin, platelets, and red blood cells. The cause of death was asphyxia secondary to airway obstruction by thrombus. We present these 2 unusual cases of asphyxia and review of the literature focusing on asphyxia and the etiology of airway thrombi.
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Affiliation(s)
- Kim A Collins
- Department of Pathology and Laboratory Medicine, Forensic and Autopsy Pathology, Medical University of South Carolina, Charleston, 29425, USA.
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45
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Thangathurai D, Roffey P, Mogos M, Riad M, Bohorguez A. Mediastinal haemorrhage mimicking tamponade during en-bloc oesophagectomy. Eur J Anaesthesiol 2005; 22:555-6. [PMID: 16045149 DOI: 10.1017/s0265021505240942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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46
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47
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Case report: a ball valve blood clot in the airways - life-saving whole tube suction. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2004; 8:R289-90. [PMID: 15469570 PMCID: PMC1065016 DOI: 10.1186/cc2903] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2004] [Accepted: 06/09/2004] [Indexed: 11/10/2022]
Abstract
Respiratory tract obstruction due to a blood clot may result in life threatening ventilatory impairment. Ball valve blood clot obstructions of the airways are rare. A ball valve blood clot acts as a one-way valve, allowing (near) normal air entry into the airways, but (completely) blocking expiration. In a near fatal case of obstruction of the airways by a ball valve blood clot, we performed 'whole tube suction' to resolve the airway problem.
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48
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Freitag L, Macha HN. [Hemoptysis]. Internist (Berl) 2004; 45:555-64. [PMID: 15054577 DOI: 10.1007/s00108-004-1173-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hemoptysis is a potentially life-threatening complication of various diseases. The most common causes are infectious and inflammatory processes, followed by neoplasms, pulmonary embolisms, mitral stenoses, coagulopathies, and multiple systemic disorders. Primary examinations include a chest x-ray, an angio CT and a bronchoscopy. Sometimes, a bronchial artery angiogram is required. The patient is at risk of suffocation because blood and clots can severely obstruct his airways. Thus, the most important measures are: supplemental oxygen, positioning the patient with the bleeding side down, bronchoscopical suctioning and removal of blood and clots. Coagulopathies have to be corrected. Application of vasoactive drugs may help temporarily. In cases of bleeding from central lesions, coagulation with laser or argon-plasma-coagulator is feasible. Heavy bleeding from the periphery requires a balloon or tube tamponade. Depending on the cause and the severity of the bleeding either anti-inflammatory medical treatment, hemostyptic radiation therapy, bronchial artery embolisation or a surgical procedure must follow.
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Barker JM, Sahn SA. Opacified Hemithorax With Ipsilateral Mediastinal Shift After Transthoracic Needle Biopsy. Chest 2003; 124:2391-2. [PMID: 14665527 DOI: 10.1378/chest.124.6.2391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- John M Barker
- Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, SC 29208, USA
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Abstract
Clotted blood or organised thrombus in the lower airway may present clinicians with life-threatening airway obstruction or pulmonary collapse. An alternative suction technique is described, which applies suction directly to a tracheal tube.
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Affiliation(s)
- A R Bodenham
- Anaesthesia and Intensive Care, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK.
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