scholarly journals A rare case of persistent air leak: beware of all the tubes

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Amarja Ashok Havaldar ◽  
Abdul Rahim Fazal ◽  
Abhilash Chennabasappa
Keyword(s):  
Mechanical Ventilation ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Muscles ◽  
Air Leak ◽  
Ventilator Support ◽  
Case Presentation ◽  
Health Care Center ◽  
Ventilation Monitoring ◽  
Persistent Air Leak

Abstract Background Patients with acute respiratory failure, impaired consciousness, and impaired airway reflexes will require invasive mechanical ventilation. Monitoring of such patients is important. The use of ventilator scalars and loops help in monitoring, diagnosing the abnormality, and treating the patients effectively. We report a rare cause one should suspect in a case of persistent and fixed air leak in a patient requiring mechanical ventilation. Case presentation We describe a 28-year-old young patient requiring ventilator support due to neuromuscular weakness. His neuromuscular weakness was rapidly progressing involving the respiratory muscles. The patient was intubated and put on mechanical ventilator support. He was transferred from another health care center to our hospital. On evaluation, the patient was intubated with ETT no 8. The patient had persistent air leak as observed on the ventilator graphics. We checked for ETT cuff malfunction, ventilator circuit, catheter mount, and HME for any disconnection causing the leak. The air leak which we observed in our patient was due to the malpositioned Ryle’s tube. Conclusions Vigilant monitoring of patients requiring mechanical ventilation is necessary. For the evaluation of the cause of air leak, algorithmic approach will help in correctly identifying the abnormality.

scholarly journals Ultrasonographic assessment of parasternal intercostal muscles during mechanical ventilation

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Paolo Formenti ◽  
Michele Umbrello ◽  
Martin Dres ◽  
Davide Chiumello
Keyword(s):  
Mechanical Ventilation ◽  
Ultrasound Imaging ◽  
Muscle Weakness ◽  
Respiratory Muscle ◽  
Muscle Activation ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Muscles ◽  
Course Of Illness ◽  
Intercostal Muscles ◽  
Predictive Parameters

Abstract Although mechanical ventilation is a lifesaving treatment, abundant evidence indicates that its prolonged use (1 week or more) promotes respiratory muscle weakness due to both contractile dysfunction and atrophy. Along with the diaphragm, the intercostal muscles are one of the most important groups of respiratory muscles. In recent years, muscular ultrasound has become a useful bedside tool for the clinician to identify patients with respiratory muscle dysfunction related to critical illness and/or invasive mechanical ventilation. Images obtained over the course of illness can document changes in muscle dimension and can be used to estimate changes in function. Recent evidence suggests the clinical usefulness of ultrasound imaging in the assessment of intercostal muscle function. In this narrative review, we summarize the current literature on ultrasound imaging of the parasternal intercostal muscles as used to assess the extent of muscle activation and muscle weakness and its potential impact during discontinuation of mechanical ventilation. In addition, we proposed a practical flowchart based on recent evidence and experience of our group that can be applied during the weaning phase. This approach integrates multiple predictive parameters of weaning success with respiratory muscle ultrasound.

scholarly journals Barrett's esophagitis related bronchoesophageal fistula - the diagnostic value of persistent air leak in the ventilated setting

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
O Halaweh ◽  
Saad Z. Usmani ◽  
R Abouasaleh
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Tracheoesophageal Fistula ◽  
Primary Closure ◽  
Diagnostic Value ◽  
Air Leak ◽  
Bronchoesophageal Fistula ◽  
Mechanically Ventilated ◽  
Short Course ◽  
Persistent Air Leak

A case of acquired tracheoesophageal fistula (TEF) is presented in a 44-year-old female who presented with acute respiratory failure due to bilateral aspiration pneumonia. The patient had persistent air leak while on mechanical ventilation and underwent bronchoscopy which revealed the above etiology. Histopathology showed Barrett's esophagitis. The patient underwent primary closure followed by a short course of proton pump inhibitors. There are only two prior reported cases of acquired TEF associated with Barrett's esophagitis. This condition should be taken under consideration when investigating of an explained persistent air leak in a mechanically ventilated patient.

scholarly journals Combined intrapleural and intrabronchial injection of fibrin glue for closing alveolar pleural fistula: a case report

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Alfonso Fiorelli ◽  
Italia Odierna ◽  
Daniele Scarano ◽  
Francesco Caronia ◽  
Andrea Failla ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Fibrin Glue ◽  
Percutaneous Dilatational Tracheostomy ◽  
High Risk Patient ◽  
Necrotizing Pneumonia ◽  
Air Leak ◽  
Additional Method ◽  
Case Presentation ◽  
Fiber Bronchoscopy ◽  
Persistent Air Leak

Abstract Background The treatment of persistent air leak is a challenge. Herein, we reported the combined intrabronchial and intrapleural injection of fibrin glue using fiber bronchoscopy to seal off an alveolar pleura fistula developed following necrotizing pneumonia in high-risk patient. Case presentation A 74-year-old man was intubated in emergency for acute ischemic stroke. Percutaneous dilatational tracheostomy was then performed, and 15 days later patient returned to spontaneous breathing. However, he developed alveolar pleural fistula following necrotizing pneumonia with persistent air leaks. The intrabronchial and intrapleural injection of fibrin glue using fiber bronchoscopy sealed off the alveolar pleura fistula after that other endoscopic treatments as bronchial valve and intrabronchial fibrin glue application had failed. Conclusions Our strategy is safe and easy to reproduce. It represents an additional method in the armamentarium of the physicians for the management of PAL when all standard strategies are unfeasible or fail.

Association between CHA2DS2-VASc score and in-hospital death in ICU patients with COVID-19

2021 ◽  
Vol 4 (4) ◽  
pp. 595-600
Author(s):  
Mukesh Jha ◽  
Utkarsh Mukesh Balani ◽  
Vimlesh Pandey ◽  
Prachi Balani ◽  
Vipin Patel ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Blood Cells ◽  
Care Center ◽  
White Blood Cells ◽  
Hospital Death ◽  
P Value ◽  
Icu Patients ◽  
Health Care Center ◽  
Significant Difference ◽  
Discharged Patients

Background: CHA2DS2-VASc score is a scientifically proven risk assessment score for patients with atrial fibrillation. It may be a good predictor of in-hospital death in COVID-19 patients. The present study aimed to evaluate the association between CHA2DS2-VASc score and in-hospital mortality in the prognosis of intensive care unit (ICU) patients with COVID-19. Methods: Eighty-four COVID-19 patients who were hospitalized in the ICU were retrospectively analyzed in a tertiary health care center, and the CHA2DS2-VASc score was determined. All analyses were performed using SPSS statistical software (SPSS Inc., Chicago, IL, USA, 20.0). A p-value <0.05 was considered statistically significant. Results: The median age of patients was 60.0 years, and most were males (75.0%). Findings of the study showed that the CHA2DS2-VASc score was considerably higher among the hospitalized patients than discharged patients (3.08 ± 1.72 vs. 1.38 ± 1.16; p<0.001), and patients who required mechanical ventilation compared to those who did not require mechanical ventilation (3.03 ± 1.68 vs. 1.15 ± 0.97; P <0.001), respectively. Patients with CHA2DS2-VASc score of ≥3 had substantially higher age [67(45-87) vs. 58(19-75); P ˂0.001], computed tomography involvement score [67.5(20-90) vs. 35(15-90); P ˂0.001] and need for mechanical ventilation [29(90.6%) vs. 22(42.3%); P ˂0.001]. A significant difference was found in oxygen saturation on admission (P =0.001) between the two groups. In-hospital death was significantly higher among patients with a CHA2DS2-VASc score of ≥3 (P <0.001). The CHA2DS2-VASc score was positively correlated with white blood cells count (r=0.257, P =0.018) and negatively correlated with the number of days spent in the hospital (r=-0.184, P=0.130) due to higher in-hospital death in ICU patients with COVID-19. Conclusion: CHA2DS2-VASc score may be an effective tool to estimate in-hospital death in COVID-19 patients who were hospitalized in the ICU.

scholarly journals 439. Clinical Characteristics and Mortality of an Initial Cohort of COVID-19 Patients in México City

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S287-S287
Author(s):  
Paulo F Castañeda-Mendez ◽  
José Luis Castillo-Álvarez ◽  
Armando Barragán-Reyes ◽  
Daniela Bay-Sansores ◽  
Jessica Isabel Pulido-Enríquez ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Mexico City ◽  
Clinical Characteristics ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Case Series ◽  
Special Focus ◽  
Tertiary Care Center ◽  
Initial Cohort

Abstract Background As of today, more than 8 million people have been infected and around 440,000 of them have lost their lives due to complications of SARS-CoV-2 infection. The first confirmed case of COVID-19 in Mexico was on February 28, 2020, and currently, there are more than 150,300 confirmed cases and more than 17,500 deaths have been reported, this work presents the characteristics of the first cases on a tertiary care center with special focus on common comorbidities in Mexicans. Methods We conducted a case series of patients with the diagnosis of pneumonia due to SARS-CoV-2 virus admitted to a tertiary care center in Mexico City, between March 14th and May 4th, 2020. Data collected included demographic information, comorbidities, clinical presentation, and outcomes. Regarding clinical outcomes, we measured the need of admission to Intensive Care Unit (ICU), mortality during hospitalization, discharge, and patients that remained hospitalized. Results 85 patients were included, median age 53.5 years; 69.4% were male. Most common clinical manifestations at admission were fever (61, 71.8%), cough (29, 34.1%), headache (25, 29.4%) and dyspnea (22, 25.9%). Most common comorbidities were overweight (44/82, 53.6%), obesity (25/82, 30.5%), hypertension (18, 21.2%), and diabetes (17, 20%). 31 of 85 (36.5%) patients were diagnosed with critical disease, whereas 54 of 85 (63.5%) were classified as non-critical. In the 31 critically ill patients, the length of invasive mechanical ventilation was 13 days [range {2–45}]; 5 patients (16.1%) required tracheostomy. The mean of mechanical ventilation prior to tracheostomy was 19.8 days [range {14–25}]. In all patients, the total length of hospitalization was 12.1 days [range {2–52}], 14.8 days [range {3–52}] in ICU patients, and 6.7 days [range {2–30}] in floor unit patients. No readmissions were documented. Global mortality was 4.7% (9.6% in ICU, 1.8% in floor unit). Of the 4 deceased patients, 3 presented comorbidities (75%), while 1 was previously healthy, documenting massive pulmonary embolism as the cause of sudden death. Conclusion This study shows that the clinical characteristics in this initial cohort are not different that described elsewhere. Mortality is low but it is mainly related to prevalent comorbidities in the Mexican population. Disclosures All Authors: No reported disclosures

scholarly journals Utility of Endobronchial Valves in a Patient with Bronchopleural Fistula in the Setting of COVID-19 Infection: A Case Report and Brief Review

2021 ◽  
Vol 23 (4) ◽  
pp. 109-114
Author(s):  
Nazanin Sheikhan ◽  
◽  
Elizabeth Benge ◽  
Amanpreet Kaur ◽  
Jerome Hruska ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Case Report ◽  
Distress Syndrome ◽  
Bronchopleural Fistula ◽  
Invasive Mechanical Ventilation ◽  
Air Leak ◽  
Mechanically Ventilated ◽  
Growing Body ◽  
Endobronchial Valve

Patients with COVID-19 pneumonia frequently develop acute respiratory distress syndrome (ARDS), and in severe cases, require invasive mechanical ventilation. One complication that can develop in patients with ARDS who are mechanically ventilated is a bronchopleural fistula (BPF). Although rare, the frequency of BPF in patients with COVID-19 pneumonia is increasingly recognized. Here, we present a 48-year old man with BPF associated with COVID-19 pneumonia. Treatment with a commercial endobronchial valve (EBV) system resulted in reduced air leak allowing for tracheostomy placement. Our case adds to a growing body of evidence suggesting that the presence of COVID-19 pneumonia does not hinder the utility of EBV’s in the treatment of BPF’s.

scholarly journals Outcomes of mechanically ventilated patients with COVID-19 associated respiratory failure

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242651
Author(s):  
Christopher S. King ◽  
Dhwani Sahjwani ◽  
A. Whitney Brown ◽  
Saad Feroz ◽  
Paula Cameron ◽  
...  
Keyword(s):  
Health Care ◽  
Mechanical Ventilation ◽  
Health System ◽  
Health Care System ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Advanced Age ◽  
Record Review ◽  
Care System

Purpose The outcomes of patients requiring invasive mechanical ventilation for COVID-19 remain poorly defined. We sought to determine clinical characteristics and outcomes of patients with COVID-19 managed with invasive mechanical ventilation in an appropriately resourced US health care system. Methods Outcomes of COVID-19 infected patients requiring mechanical ventilation treated within the Inova Health System between March 5, 2020 and April 26, 2020 were evaluated through an electronic medical record review. Results 1023 COVID-19 positive patients were admitted to the Inova Health System during the study period. Of these, 164 (16.0%) were managed with invasive mechanical ventilation. All patients were followed to definitive disposition. 70/164 patients (42.7%) had died and 94/164 (57.3%) were still alive. Deceased patients were older (median age of 66 vs. 55, p <0.0001) and had a higher initial d-dimer (2.22 vs. 1.31, p = 0.005) and peak ferritin levels (2998 vs. 2077, p = 0.016) compared to survivors. 84.3% of patients over 70 years old died in the hospital. Conversely, 67.4% of patients age 70 or younger survived to hospital discharge. Younger age, non-Caucasian race and treatment at a tertiary care center were all associated with survivor status. Conclusion Mortality of patients with COVID-19 requiring invasive mechanical ventilation is high, with particularly daunting mortality seen in patients of advanced age, even in a well-resourced health care system. A substantial proportion of patients requiring invasive mechanical ventilation were not of advanced age, and this group had a reasonable chance for recovery.

Ventilator Liberation Strategies

2014 ◽  
Author(s):  
Stefano Nava ◽  
Luca Fasano
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Decision Making ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Muscles ◽  
Clinical Decision ◽  
Fully Integrated ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Increased Risk

The weaning process should ideally begin as soon as the patient is intubated and continue through the treatment of the cause inducing acute respiratory failure. Weaning includes the assessment of readiness to extubate, extubation, and post-extubation monitoring; it also includes consideration of non-invasive ventilation which has been shown to reduce the duration of invasive mechanical ventilation in selected patients. Weaning accounts for approximately 40% of the total time spent on mechanical ventilation and should be achieved rapidly, since prolonged mechanical ventilation is associated with increased risk of complications and mortality and with increased costs. During mechanical ventilation, medical management should seek to correct the imbalance between respiratory load and ventilatory capacity (reducing the respiratory and cardiac workload, improving gas exchange and the ventilatory pump power). Ventilator settings delivering partial ventilatory pump support may help prevent ventilator-induced respiratory muscles dysfunction. Daily interruption of sedation has been associated with earlier extubation. Critically ill patients should be repeatedly and carefully screened for readiness to wean and readiness to extubate, and objective screening variables should be fully integrated in clinical decision making.

scholarly journals Pneumomediastinum Mimicking Congenital Pulmonary Airway Malformation

Children ◽  
2019 ◽  
Vol 6 (9) ◽  
pp. 104
Author(s):  
Kylat
Keyword(s):  
Mechanical Ventilation ◽  
Pressure Support ◽  
Positive Airway Pressure ◽  
Invasive Mechanical Ventilation ◽  
Air Leak ◽  
Ultrasound Guided ◽  
Congenital Pulmonary Airway Malformation ◽  
Non Invasive ◽  
Hemodynamic Compromise ◽  
Free Air

Pneumomediastinum is the collection of free air in the mediastinum. Its incidence is higher in preterm infants and those on positive airway pressure support or on mechanical ventilation. But it has decreased dramatically after the introduction of surfactant and synchronized, non-invasive mechanical ventilation. Underlying cystic lesions could also increase the risk of pneumomediastinum and other air leak syndromes. Most cases resolve spontaneously but rare hemodynamic compromise may require ultrasound-guided intervention.

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