scholarly journals 402. Spontaneous pneumothorax in COVID-19

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S269-S269
Author(s):  
Zain Tariq ◽  
Diana Doeing ◽  
Varidhi Nauriyal ◽  
Zohra Sarfraz Chaudhry ◽  
Anita Shallal ◽  
...  
Keyword(s):  
Spontaneous Pneumothorax ◽  
Late Complication ◽  
Tension Pneumothorax ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Hospitalized Patients ◽  
Tube Placement ◽  
Positive Pressure ◽  
Chest Imaging ◽  
Bilateral Pneumothorax

Abstract Background Pneumothorax has been reported with the use of positive pressure ventilation in COVID-19 pneumonia. Literature on spontaneous pneumothorax (PTX) in COVID-19 patients is scant. We present a case series of 7 patients with COVID-19 pneumonia, who developed spontaneous pneumothorax without prior mechanical ventilation. Methods A retrospective chart review of 7 cases was performed from two different hospitals in the US between 4/6/2020–5/15/2020. Hospitalized patients with confirmed COVID-19 by nasopharyngeal RT-PCR who developed spontaneous pneumothorax were included. Collected data included demographics, co-morbidities, inflammatory biomarkers, chest imaging and management strategies. Length of stay, transfer to intensive care unit and death were the assessed outcomes. A descriptive analysis was done. Results There were 3 patients from Henry Ford Health System, Michigan and 4 patients from Silver Cross Hospital, Illinois. Median age was 75 years and 6 out of 7 (85.7%) were males (Table 1). There were no co-morbidities associated with spontaneous pneumothorax except for one patient with COPD. None of the patients’ imaging prior to diagnosis of pneumothorax revealed any underlying blebs. Median time from symptom onset to diagnosis of pneumothorax was 17 days. One of the patients had tension pneumothorax, two had bilateral pneumothorax and three had pneumomediastinum (Figure 1). Four patients required chest tube placement, three required escalation to ICU, of which two died. Table 1. Demographics and Clinical Characteristics of Patients with Spontaneous Pneumothorax Figure 1. CT imaging before (left) and after (right) Spontaneous Pneumothorax Conclusion Spontaneous pneumothorax may be an unrecognized late complication of COVID-19 pneumonia. In hospitalized patients with acute respiratory decompensation, spontaneous pneumothorax should be considered as part of the differential diagnosis. Repeat chest imaging should be considered in these cases. Disclosures All Authors: No reported disclosures

scholarly journals Connecting Hospitalized Patients with Their Families: Case Series and Commentary

2011 ◽  
Vol 2011 ◽  
pp. 1-7
Author(s):  
Kourosh Parsapour ◽  
Alexander A. Kon ◽  
Madan Dharmar ◽  
Amy K. McCarthy ◽  
Hsuan-Hui Yang ◽  
...  
Keyword(s):  
Close Contact ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Family Satisfaction ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Patient Centered ◽  
Family Presence ◽  
Telemedicine Service ◽  
Personal Cost

The overall aim of this project was to ascertain the utilization of a custom-designed telemedicine service for patients to maintain close contact (via videoconference) with family and friends during hospitalization. We conducted a retrospective chart review of hospitalized patients (primarily children) with extended hospital length of stays. Telecommunication equipment was used to provide videoconference links from the patient's bedside to friends and family in the community. Thirty-six cases were managed during a five-year period (2006 to 2010). The most common reasons for using Family-Link were related to the logistical challenges of traveling to and from the hospital—principally due to distance, time, family commitments, and/or personal cost. We conclude that videoconferencing provides a solution to some barriers that may limit family presence and participation in care for hospitalized patients, and as a patient-centered innovation is likely to enhance patient and family satisfaction.

Bilateral Tension Pneumothorax Related to Acupuncture

2013 ◽  
Vol 31 (2) ◽  
pp. 242-244 ◽  
Author(s):  
Rumi Tagami ◽  
Takashi Moriya ◽  
Kosaku Kinoshita ◽  
Katsuhisa Tanjoh
Keyword(s):  
Risk Factors ◽  
Spontaneous Pneumothorax ◽  
Rare Case ◽  
Vital Signs ◽  
Tension Pneumothorax ◽  
Complete Information ◽  
Definitive Diagnosis ◽  
Shortness Of Breath ◽  
Chest Tubes ◽  
Bilateral Pneumothorax

We report on a patient with a rare case of bilateral tension pneumothorax that occurred after acupuncture. A 69-year-old large-bodied man, who otherwise had no risk factors for spontaneous pneumothorax, presented with chest pressure, cold sweats and shortness of breath. Immediately after bilateral pneumothorax had been identified on a chest radiograph in the emergency room, his blood pressure and percutaneous oxygen saturation suddenly decreased to 78 mm Hg and 86%, respectively. We confirmed deterioration in his cardiopulmonary status and diagnosed bilateral tension pneumothorax. We punctured his chest bilaterally and inserted chest tubes for drainage. His vital signs promptly recovered. After the bilateral puncture and drainage, we learnt that he had been treated with acupuncture on his upper back. We finally diagnosed a bilateral tension pneumothorax based on the symptoms that appeared 8 h after the acupuncture. Because the patient had no risk factors for spontaneous pneumothorax, no alternative diagnosis was proposed. We recommend that patients receiving acupuncture around the chest wall must be adequately informed of the possibility of complications and expected symptoms, as a definitive diagnosis can be difficult without complete information.

Case Series: Tension Pneumothorax Complicating Narrow-Bore Enteral Feeding Tube Placement

2010 ◽  
Vol 25 (5) ◽  
pp. 281-285 ◽  
Author(s):  
Sheldon Y. Freeberg ◽  
Thomas P. Carrigan ◽  
Daniel A. Culver ◽  
Jorge A. Guzman
Keyword(s):  
Enteral Feeding ◽  
Tension Pneumothorax ◽  
Case Series ◽  
Feeding Tube ◽  
Tube Placement ◽  
Enteral Feeding Tube ◽  
Feeding Tube Placement

scholarly journals Traumatic occurrence of chest wall tamponade secondary to subcutaneous emphysema

CJEM ◽  
2008 ◽  
Vol 10 (04) ◽  
pp. 387-391 ◽  
Author(s):  
Michael Perraut ◽  
Daniel Gilday ◽  
Gordon Reed
Keyword(s):  
Respiratory Failure ◽  
Subcutaneous Emphysema ◽  
Unusual Case ◽  
Positive Pressure Ventilation ◽  
Tension Pneumothorax ◽  
Tube Placement ◽  
Positive Pressure ◽  
Management Options ◽  
Physical Finding ◽  
Life Threatening

ABSTRACTSubcutaneous emphysema is a physical finding that itself is usually perceived as benign yet rarely may, in and of itself, be life-threatening. We present an unusual case of a 67-year-old woman who developed delayed severe subcutaneous emphysema and tension pneumothorax from a rib fracture subsequent to a fall. We review the pathophysiology, manifestations and management options of this disorder. In patients whose clinical condition allows it, chest tube placement prior to intubation should be considered. Furthermore, positive end-expiratory pressure should be minimized. We present a case that illustrates how subcutaneous emphysema itself can be a potential cause of respiratory failure and tamponade physiology. In our case, a patient with traumatic subcutaneous emphysema developed respiratory failure and clinical deterioration after the introduction of positive pressure ventilation. In such rare scenarios, care should be taken to consider the absolute need for positive pressure ventilation without surgical decompression.

scholarly journals Pneumothorax as a Complication of Liposuction

2020 ◽  
Vol 40 (7) ◽  
pp. 753-758 ◽  
Author(s):  
James A Mentz ◽  
Henry A Mentz ◽  
Stephanie Nemir
Keyword(s):  
Risk Factors ◽  
Rare Complication ◽  
Retrospective Chart Review ◽  
Lung Parenchyma ◽  
Scar Tissue ◽  
Tube Placement ◽  
Positive Pressure ◽  
Level Of Evidence ◽  
Axillary Region ◽  
Initial Sign

Abstract Background Pneumothorax is a rare complication of liposuction resulting from injury to the lung parenchyma. Objectives This study aimed to determine the incidence of pneumothorax complicating liposuction, describe an archetypal presentation, identify risk factors, and propose options for risk reduction. Methods In a retrospective chart review, liposuction procedures performed over a 16-year period by 8 surgeons in 1 practice were screened for pneumothorax. Cases featuring pneumothorax were analyzed to ascertain risk factors, presentation, and pathogenesis. Results Among the 16,215 liposuction procedures performed during the study period, 7 pneumothoraxes were identified (0.0432%). Six (85.7%) were female. Three (42.9%) had previous liposuction. Six cases (85.7%) included liposuction of the axillary region. All cases featured depression of intra/postoperative oxygen saturations as the initial sign. Three (42.9%) were identified intraoperatively. All patients were transferred to a hospital for imaging. Five (71.4%) underwent chest tube placement. Two (28.6%) were treated with observation alone. Pneumothoraxes were left-sided in 4 cases (57.1%), and right-sided in 3 cases (42.9%). In early cases, 1.5-mm infiltration cannulas were used; in 2016 cannula size was changed to 3-4 mm for infiltration and 4-5 mm for liposuction. Conclusions Possible risk factors for pneumothorax include liposuction of the axilla, use of flexible infiltration cannulas, and scarring from previous liposuction. We recommend including pneumothorax as a potential complication during informed consent, performing infiltration with a stiff >3.5-mm cannula, minimizing positive-pressure ventilation, emphasized awareness of cannula tip location in all patients but particularly in patients with previous liposuction or scar tissue, and increased caution when operating in the axillary area. Level of Evidence: 4

scholarly journals Metastatic Pulmonary Angiosarcoma Presenting With Bilateral Secondary Spontaneous Pneumothoraces

2016 ◽  
Vol 32 (4) ◽  
pp. 292-296
Author(s):  
Daniel Jimenez ◽  
James Antaki ◽  
Nader Kamangar
Keyword(s):  
Chest Tube ◽  
Spontaneous Pneumothorax ◽  
Tension Pneumothorax ◽  
Disease Process ◽  
Tube Placement ◽  
Lung Pathology ◽  
Severe Respiratory Distress ◽  
Chest Tube Placement ◽  
High Propensity ◽  
Rare Malignancy

Background: Spontaneous pneumothorax (SP) is uncommon and can present as a primary disease process or as a result of underlying lung pathology. Several parenchymal lung diseases, such as malignancy, are known to cause SP. One such malignancy, angiosarcoma, has a high propensity to metastasize to the lung and present as cavitary and cystic lesions. Case: We present a case of a 76-year-old male diagnosed with angiosarcoma of the scalp that was found to have extensive cystic pulmonary metastatic lesions. Soon after his initial diagnosis, he presented with severe respiratory distress secondary to a spontaneous left-sided pneumothorax. After intubation and left-sided chest tube placement, the patient developed a right-sided tension pneumothorax requiring emergent chest tube placement. Conclusion: Cutaneous angiosarcoma is a rare malignancy that frequently metastasizes the lung. Spontaneous pneumothorax can be the presenting manifestation of the disease and often results in respiratory failure.

scholarly journals Clamping of chest drain before removal in spontaneous pneumothorax

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yu-Hong Chan ◽  
Ellen Lok-Man Yu ◽  
Hau-Chung Kwok ◽  
Yiu-Cheong Yeung ◽  
Wai-Cho Yu
Keyword(s):  
Spontaneous Pneumothorax ◽  
Chart Review ◽  
Tension Pneumothorax ◽  
Retrospective Chart Review ◽  
Early Recurrence ◽  
Chest Drain ◽  
Air Leak ◽  
Recurrence Group ◽  
Prolong Hospital Stay ◽  
New Onset

Abstract Background In spontaneous pneumothorax, clamping the chest drain before its removal may avoid reinsertion in case of early recurrence, but may be unsafe and may prolong hospital stay. The objective of this study was to examine the incidence of early recurrence in both clamped and unclamped pneumothorax episodes, and factors associated with it. Methods Retrospective chart review of primary and secondary spontaneous pneumothorax episodes in which chest drain was inserted during the period April 2012 to March 2014. Results Data of 122 episodes were analysed. There were 36 primary pneumothorax and 86 secondary pneumothorax episodes. Mean age was 59 years with 92% males. Clamping of the chest drain was done in 68 episodes (55.7%), and not done in 54. The clamping group was significantly younger, had more primary pneumothorax, and had shorter time from cessation of air leak to clamp/removal. Recurrence within 24 h were seen in 12 (17.6%) clamped episodes and 4 (7.4%) non-clamped episodes, although in only eight episodes were reinsertion of chest drain saved. Significantly more previous pneumothorax episodes were seen in the early recurrence group. We observed no new onset of tension pneumothorax or subcutaneous emphysema associated with clamping. Conclusion The practice of clamping the chest drain before removal in spontaneous pneumothorax appear safe. Clamping saved chest drain reinsertion in 11.8% of cases, and has the potential to save more if clamped for up to 24 h. However, clamping may result in more early recurrences. Prospective randomised studies are needed.

Melatonin as adjuvant treatment for coronavirus disease 2019 pneumonia patients requiring hospitalization (MAC-19 PRO): a case series

2020 ◽  
Vol 3 (3) ◽  
pp. 297-310 ◽  
Author(s):  
Rafael Ricafranca Castillo ◽  
Gino Rei A. Quizon ◽  
Mario Joselito M. Juco ◽  
Arthur Dessi E. Roman ◽  
Donnah G De Leon ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Hospital Stay ◽  
Clinical Improvement ◽  
Case Series ◽  
High Dose ◽  
Chest Imaging ◽  
Imaging Findings ◽  
Rt Pcr ◽  
Average Hospital ◽  
Sleeping Problems

 Treatment for coronavirus disease 2019 (COVID19) pneumonia remains empirical and the search for therapies that can improve outcomes continues. Melatonin has been shown to have anti-inflammatory, antioxidant, and immune-modulating effects that may address key pathophysiologic mechanisms in the development and progression of acute respiratory distress syndrome (ARDS), which has been implicated as the likely cause of death in COVID19. We aimed to describe the observable clinical outcomes and tolerability of high-dose melatonin (hdM) given as adjuvant therapy in patients admitted with COVID19 pneumonia. We conducted a retrospective descriptive case series of patients who: 1) were admitted to the Manila Doctors Hospital in Manila, Philippines, between March 5, 2020 and April 4, 2020; 2) presented with history of typical symptoms (fever, cough, sore throat, loss of smell and/or taste, myalgia, fatigue); 3) had admitting impression of atypical pneumonia; 4) had history and chest imaging findings highly suggestive of COVID19 pneumonia, and, 5) were given hdM as adjuvant therapy, in addition to standard and/or empirical therapy. One patient admitted to another hospital, who one of the authors helped co-manage, was included. He was the lone patient given hdM in that hospital during the treatment period. Main outcomes described were: time to clinical improvement, duration of hospital stay from hdM initiation, need for mechanical ventilation (MV) prior to cardiopulmonary resuscitation, and final outcome (death or recovery/discharge). Of 10 patients given hdM at doses of 36-72mg/day per os (p.o.) in 4 divided doses as adjuvant therapy, 7 were confirmed COVID19 positive (+) by reverse transcription polymerase chain reaction (RT-PCR) and 3 tested negative  (-), which was deemed to be false (-) considering the patients’ typical history, symptomatology, chest imaging findings and elevated bio-inflammatory parameters.  In all 10 patients given hdM, clinical stabilization and/or improvement was noted within 4-5 days after initiation of hdM. All hdM patients, including 3 with moderately severe ARDS and 1 with mild ARDS, survived; none required MV. The 7 COVID19(+) patients were discharged at an average of 8.6 days after initiation of hdM. The 3 highly probable COVID19 patients on hdM were discharged at an average of 7.3 days after hdM initiation. Average hospital stay of those not given hdM (non-hdM) COVID19(+) patients who were admitted during the same period and recovered was 13 days. To provide perspective, although the groups are not comparable, 12 of the 34 (35.3%) COVID19(+) non-hdM patients admitted during the same period died, 7/34 (20.6%) required MV; while 6 of 15 (40%) non-hdM (-) by RT-PCR but highly probable COVID19 pneumonia patients also died, 4/15  (26.7%) required MV. No significant side-effects were noted with hdM except for sleepiness, which was deemed favorable by all patients, most of whom had anxiety- and symptom-related sleeping problems previously. HdM may have a beneficial role in patients treated for COVID19 pneumonia, in terms of shorter time to clinical improvement, less need for MV, shorter hospital stay, and possibly lower mortality. HdM was well tolerated. This is the first report describing the benefits of hdM in patients being treated for COVID19 pneumonia.  Being a commonly available and inexpensive sleep-aid supplement worldwide, melatonin may play a role as adjuvant therapy in the global war against COVID19. 

scholarly journals A preliminary assessment of guideline adherence and clinical variation in oral cancer treatment: a MarketScan database study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Antoine Eskander ◽  
Axel Sahovaler ◽  
Jennifer Shin ◽  
Konrado Deutsch ◽  
Matthew Crowson ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Radiation Treatment ◽  
Tube Placement ◽  
Adjuvant Chemoradiotherapy ◽  
Research Database ◽  
Chest Imaging ◽  
Geographical Differences ◽  
Processes Of Care ◽  
North East ◽  
Multidisciplinary Consultation

Abstract Background To assess variations in adherence to guideline-recommended processes of care for oral cavity cancer patients. Methods Retrospective study using a U.S. healthcare research database (MarketScan). Index diagnoses were considered from 2010 to 2012 with follow-up from 2013 to 2014. Diagnostic and procedure codes were utilized to identify oral cavity patients with a defined treatment modality. Compliance with guideline-recommended processes of care, which included pre-treatment imaging, thyroid-function testing (TFTs), multidisciplinary consultation and gastrostomy-tube insertion rates, were assessed. Results A total of 2752 patients were identified. Surgery alone was the most common treatment (60.8%), followed by surgery with adjuvant chemoradiotherapy (20.4%) and surgery with adjuvant radiotherapy (18.8%). Head/neck and chest imaging were obtained in 60% and 62.5% of patients respectively. Significant geographical differences in head and neck imaging were observed between North-central (64%), South (58.4%) and West (56.1%) regions (p = 0.026). Differences in chest imaging were also present between North-east (65%) and West (56.8%; p = 0.007). TFTs were obtained in 54.4% of the patients after radiation treatment, and 18.6% of patients had multidisciplinary consultation during the 6 months before and 3 months after initiation of treatment. During the year after treatment initiation, 21.2% of patients underwent G-tube placement, with significantly higher rates in patients receiving triple modality treatment (58%) when compared to surgery plus radiation (27%) and surgery alone (15%; p < 0.01). Conclusion Adherence to evidence-based practices was low based on the database coding. These data suggest a potential to improve adherence and increase the routine use of practices delineated in national clinical practice guidelines. Clinical relevance This study reflects a suboptimal adherence to guidelines based on the database employed. This study should be considered by healthcare providers and efforts should be maximized to follow the processes of care which have proven to impact on patient's outcomes.

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