scholarly journals Tractotomy using the Penrose drain guide for deep lung injury caused by chest drainage: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hironori Oyamatsu ◽  
Hideki Tsubouchi ◽  
Kunio Narita
Keyword(s):  
Lung Injury ◽  
Chest Tube ◽  
Drain Tube ◽  
Chest Drainage ◽  
Respiratory Condition ◽  
Penrose Drain ◽  
Multiple Rib Fractures ◽  
Lung Injuries ◽  
The Right ◽  
Damaged Vessel

Abstract Background Pulmonary tractotomy effectively treats deep pulmonary penetrating injuries; however, it requires the accurate insertion of forceps or a stapler into the wound tract. This report describes a case of tractotomy using the Penrose drain guide for a deep lung injury caused by chest drainage. Case presentation A 75-year-old man suffered multiple rib fractures and hemothorax. After admission, chest tube drainage was performed because the patient’s respiratory condition deteriorated due to increased right pleural effusion. However, as the chest tube was stabbing into the right upper lobe, a pulmonary tractotomy was performed to treat the injury. Cutting the visceral pleura just over the tip of the chest tube caused the tube to completely penetrate the lung. A Penrose drain tube was fixed to the chest tube, which was then removed. The Penrose drain tube completely penetrated the lung and was coupled to the anvil side of the stapler to guide it smoothly into the wound tract. After stapling left the wound tract open, selective suture ligation of the damaged vessel and bronchioles was performed. Conclusions Although the indications for tractotomy using the Penrose drain guide are limited, we believe that this technique can be useful in patients with deep stabbing or penetrating lung injuries with rod- or tube-shaped foreign body remnants.

scholarly journals Airway Foreign Body Mimicking an Endobronchial Tumor Presenting with Pneumothorax in an Adult: A Case Report

Medicina ◽  
2021 ◽  
Vol 57 (1) ◽  
pp. 50
Author(s):  
Jun-Ho Ha ◽  
Byeong-Ho Jeong
Keyword(s):  
Computed Tomography ◽  
Foreign Body ◽  
Chest Tube ◽  
Biopsy Forceps ◽  
Chest Computed Tomography ◽  
Contrast Enhanced ◽  
Lobar Bronchus ◽  
Green Pea ◽  
Airway Foreign Body ◽  
The Right

Foreign body (FB) aspiration occurs less frequently in adults than in children. Among the complications related to FB aspiration, pneumothorax is rarely reported in adults. Although the majority of FB aspiration cases can be diagnosed easily and accurately by using radiographs and bronchoscopy, some patients are misdiagnosed with endobronchial tumors. We describe a case of airway FB that mimicked an endobronchial tumor presenting with pneumothorax in an adult. A 77-year-old man was referred to our hospital due to pneumothorax and atelectasis of the right upper lobe caused by an endobronchial nodule. A chest tube was immediately inserted to decompress the pneumothorax. Chest computed tomography with contrast revealed an endobronchial nodule that was seen as contrast-enhanced. Flexible bronchoscopy was performed to biopsy the nodule. The bronchoscopy showed a yellow spherical nodule in the right upper lobar bronchus. Rat tooth forceps were used, because the lesion was too slippery to grasp with ellipsoid cup biopsy forceps. The whole nodule was extracted and was confirmed to be a FB, which was determined to be a green pea vegetable. After the procedure, the chest tube was removed, and the patient was discharged without any complications. This case highlights the importance of suspecting a FB as a cause of pneumothorax and presents the possibility of misdiagnosing an aspirated FB as an endobronchial tumor and selecting the appropriate instrument for removing an endobronchial FB.

scholarly journals Simulated aeromedical evacuation exacerbates burn induced lung injury: targeting mitochondrial DNA for reversal

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Meng-Jing Xiao ◽  
Xiao-Fang Zou ◽  
Bin Li ◽  
Bao-Long Li ◽  
Shi-Jian Wu ◽  
...  
Keyword(s):  
Lung Injury ◽  
Nlrp3 Inflammasome ◽  
Hypobaric Hypoxia ◽  
Dnase I ◽  
Treatment Intervention ◽  
Aeromedical Evacuation ◽  
Hypoxia Exposure ◽  
Histopathological Evaluation ◽  
Lung Injuries ◽  
Mda Content

Abstract Background Aeromedical evacuation of patients with burn trauma is an important transport method in times of peace and war, during which patients are exposed to prolonged periods of hypobaric hypoxia; however, the effects of such exposure on burn injuries, particularly on burn-induced lung injuries, are largely unexplored. This study aimed to determine the effects of hypobaric hypoxia on burn-induced lung injuries and to investigate the underlying mechanism using a rat burn model. Methods A total of 40 male Wistar rats were randomly divided into four groups (10 in each group): sham burn (SB) group, burn in normoxia condition (BN) group, burn in hypoxia condition (BH) group, and burn in hypoxia condition with treatment intervention (BHD) group. Rats with 30% total body surface area burns were exposed to hypobaric hypoxia (2000 m altitude simulation) or normoxia conditions for 4 h. Deoxyribonuclease I (DNase I) was administered systemically as a treatment intervention. Systemic inflammatory mediator and mitochondrial deoxyribonucleic acid (mtDNA) levels were determined. A histopathological evaluation was performed and the acute lung injury (ALI) score was determined. Malonaldehyde (MDA) content, myeloperoxidase (MPO) activity, and the nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome level were determined in lung tissues. Data among groups were compared using analysis of variance followed by Tukey’s test post hoc analysis. Results Burns resulted in a remarkably higher level of systemic inflammatory cytokines and mtDNA release, which was further heightened by hypobaric hypoxia exposure (P < 0.01). Moreover, hypobaric hypoxia exposure gave rise to increased NLRP3 inflammasome expression, MDA content, and MPO activity in the lung (P < 0.05 or P < 0.01). Burn-induced lung injuries were exacerbated, as shown by the histopathological evaluation and ALI score (P < 0.01). Administration of DNase I markedly reduced mtDNA release and systemic inflammatory cytokine production. Furthermore, the NLRP3 inflammasome level in lung tissues was decreased and burn-induced lung injury was ameliorated (P < 0.01). Conclusions Our results suggested that simulated aeromedical evacuation further increased burn-induced mtDNA release and exacerbated burn-induced inflammation and lung injury. DNase I reduced the release of mtDNA, limited mtDNA-induced systemic inflammation, and ameliorated burn-induced ALI. The intervening mtDNA level is thus a potential target to protect from burn-induced lung injury during aeromedical conditions and provides safer air evacuations for severely burned patients.

scholarly journals Effects of Antibiotic Therapy on Pseudomonas aeruginosa-Induced Lung Injury in a Rat Model

1999 ◽  
Vol 43 (10) ◽  
pp. 2389-2394 ◽  
Author(s):  
Erika J. Ernst ◽  
Satoru Hashimoto ◽  
Joseph Guglielmo ◽  
Teiji Sawa ◽  
Jean-Francois Pittet ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Rat Model ◽  
In Vivo Model ◽  
Antibiotic Administration ◽  
Lung Water ◽  
Alveolar Epithelial ◽  
The Right

ABSTRACT The effect of antibiotics on the acute lung injury induced by virulent Pseudomonas aeruginosa PA103 was quantitatively analyzed in a rat model. Lung injury was induced by the instillation of PA103 directly into the right lower lobes of the lungs of anesthetized rats. The alveolar epithelial injury, extravascular lung water, and total plasma equivalents were measured as separate, independent parameters of acute lung injury. Four hours after the instillation of PA103, all the parameters were increased linearly depending on the dose of P. aeruginosa. Next, we examined the effects of intravenously administered antibiotics on the parameters of acute lung injury in d-galactosamine-sensitized rats. One hour after the rats received 107 CFU of PA103, an intravenous bolus injection of aztreonam (60 mg/kg) or imipenem-cilastatin (30 mg/kg) was administered. Despite an MIC indicating resistance, imipenem-cilastatin improved all the measurements of lung injury; in contrast, aztreonam, which had an MIC indicating sensitivity, did not improve any of the lung injury parameters. The antibiotics did not generate different quantities of plasma endotoxin; therefore, endotoxin did not appear to explain the differences in lung injury. This in vivo model is useful to quantitatively compare the efficacies of parenteral antibiotic administration on Pseudomonas airspace infections.

scholarly journals Regional Gas Exchange and Cellular Metabolic Activity in Ventilator-induced Lung Injury

2007 ◽  
Vol 106 (4) ◽  
pp. 723-735 ◽  
Author(s):  
Guido Musch ◽  
Jose G. Venegas ◽  
Giacomo Bellani ◽  
Tilo Winkler ◽  
Tobias Schroeder ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Lung Injury ◽  
Metabolic Activity ◽  
Cell Activation ◽  
Test Lung ◽  
Ventilator Induced Lung Injury ◽  
Positron Emission ◽  
Cellular Metabolic Activity ◽  
The Right ◽  
Tissue Fraction

Background Alveolar overdistension and repetitive derecruitment-recruitment contribute to ventilator-induced lung injury (VILI). The authors investigated (1) whether inflammatory cell activation due to VILI was assessable by positron emission tomography and (2) whether cell activation due to dynamic overdistension alone was detectable when other manifestations of VILI were not yet evident. Methods The authors assessed cellular metabolic activity with [(18)F]fluorodeoxyglucose and regional gas exchange with [(13)N]nitrogen. In 12 sheep, the left ("test") lung was overdistended with end-inspiratory pressure of 50 cm H(2)O for 90 min, while end-expiratory derecruitment of this lung was either promoted with end-expiratory pressure of -10 cm H(2)O in 6 of these sheep (negative end-expiratory pressure [NEEP] group) or prevented with +10 cm H(2)O in the other 6 (positive end-expiratory pressure [PEEP] group) to isolate the effect of overdistension. The right ("control") lung was protected from VILI. Results Aeration decreased and shunt fraction increased in the test lung of the NEEP group. [(18)F]fluorodeoxyglucose uptake of this lung was higher than that of the control lung and of the test lung of the PEEP group, and correlated with neutrophil count. When normalized by tissue fraction to account for increased aeration of the test lung in the PEEP group, [(18)F]fluorodeoxyglucose uptake was elevated also in this group, despite the fact that gas exchange had not yet deteriorated after 90 min of overdistension alone. Conclusion The authors could detect regional neutrophil activation in VILI even when end-expiratory derecruitment was prevented and impairment of gas exchange was not evident. Concomitant end-expiratory derecruitment converted this activation into profound inflammation with decreased aeration and regional shunting.

scholarly journals Vaping-induced lung injury: brief report for the practicing clinician

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Bashar Khiatah ◽  
Alex Murdoch ◽  
Charles Hubeny ◽  
Carl Constantine ◽  
Amanda Frugoli
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Case Vignette ◽  
Cigarette Use ◽  
Lung Injuries ◽  
Teenagers And Young Adults ◽  
The Usa ◽  
Physician Awareness ◽  
Harmful Effects

ABSTRACT The USA is witnessing an outbreak of vaping-induced lung injuries associated with the drastic rise in e-cigarette use, especially among teenagers and young adults. Our understanding of the harmful effects of these products is expanding as an increasing amount of consumers seek medical care for lung-related illnesses. The knowledge of the long-term sequelae of e-cigarette use is limited due to their novelty, but a growing association exists between use and acute lung injury. We describe a case vignette of vaping-induced lung injury to increase physician awareness and discuss the applicability of preliminary diagnostic criteria.

A positron emission tomographic comparison of diffuse and lobar oleic acid lung injury

1988 ◽  
Vol 64 (6) ◽  
pp. 2357-2365 ◽  
Author(s):  
D. P. Schuster ◽  
J. W. Haller ◽  
M. Velazquez
Keyword(s):  
Oleic Acid ◽  
Lung Injury ◽  
Dorsal Region ◽  
Lung Water ◽  
Positron Emission ◽  
Transcapillary Escape Rate ◽  
Severity Of Injury ◽  
Water Accumulation ◽  
The Right ◽  
Lung Lobes

We tested whether severity of injury measured from the pulmonary transcapillary escape rate for transferrin (PTCER), lung water accumulation, and changes in regional pulmonary blood flow (PBF) would be similar after oleic acid (OA) injection into either all lung lobes or directly into the pulmonary artery feeding the left caudal lobe (LCL) only. Measurements were made with positron emission tomography. After 0.015 ml/kg OA was injected into the LCL (Lobar, n = 5), lung water increased in the left dorsal region from 37 +/- 5 to 50 +/- 8 ml/100 ml lung (P less than 0.05), PTCER was 533 +/- 59 10(-4)/min, and regional PBF decreased 62%. No significant change occurred in the uninjured right dorsal lung where PTCER was 85 +/- 32. In the left ventral region PTCER was 357 +/- 60, PBF decreased only 31%, and the increase in lung water was less (25 +/- 3 to 30 +/- 6). In contrast after 0.08 ml/kg OA was injected via the right atrium (Diffuse, n = 6), PTCER (283 +/- 94) was lower in the left dorsal region of this group than in the corresponding region of the Lobar group (P less than 0.05). The increase in lung water, however, was the same, but no change occurred in PBF distribution. These results indicate important differences between the two methods of causing lung injury with OA. After injury lung water accumulates primarily in dependent portions of lung and is not always accompanied by a decrease in regional PBF. These decreases, when they occur, may instead indicate severe vascular injury.

scholarly journals Unusual Malposition of a Chest Tube, Intrathoracic but Extrapleural

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Alqasem Fuad H. Al Mosa ◽  
Mohammed Ishaq ◽  
Mohamed Hussein Mohamed Ahmed
Keyword(s):  
Chest Tube ◽  
Complete Resolution ◽  
Pleural Cavity ◽  
Tube Thoracostomy ◽  
Thoracic Cavity ◽  
Common Complication ◽  
Thoracostomy Tube ◽  
Chest Computed Tomography ◽  
Initial Improvement ◽  
The Right

Chest tube malpositioning is reported to be the most common complication associated with tube thoracostomy. Intraparenchymal and intrafissural malpositions are the most commonly reported tube sites. We present a case about a 21-year-old patient with cystic fibrosis who was admitted due to bronchiectasis exacerbation and developed a right-sided pneumothorax for which a chest tube was inserted. Partial initial improvement in the pneumothorax was noted on the chest radiograph, after which the chest tube stopped functioning and the pneumothorax remained for 19 days. Chest computed tomography was done and revealed a malpositioned chest tube in the right side located inside the thoracic cavity but outside the pleural cavity (intrathoracic, extrapleural). The removed chest tube was patent with no obstructing materials in its lumen. A new thoracostomy tube was inserted and complete resolution of the pneumothorax followed.

scholarly journals Anthropomorphic Blast Test Device for Primary Blast Injury Risk Assessment

2020 ◽  
Vol 185 (Supplement_1) ◽  
pp. 227-233
Author(s):  
Yun Hsu ◽  
Kevin Ho ◽  
Philemon Chan
Keyword(s):  
Risk Assessment ◽  
Lung Injury ◽  
Open Field ◽  
Injury Risk ◽  
Health Hazard ◽  
Field Tests ◽  
Blast Injury ◽  
Test Device ◽  
Blast Overpressure ◽  
Lung Injuries

Abstract Introduction Blast overpressure health hazard assessment is required prior to fielding of weapon systems that produce blast overpressures that pose risk of auditory and nonauditory blast lung injuries. The anthropomorphic blast test device (ABTD) offers a single device solution for collection of both auditory and nonauditory data from a single blast at anthropometrically correct locations for injury risk assessment. It also allows for better replication of personnel positioning during weapons firings. The ABTD is an update of the blast test device (BTD), the current Army standard for collection of thoracic blast loading data. Validation testing of the ABTD is required to ensure that lung injury model validated using BTD collected test data and sheep subjects is still applicable when the ABTD is used. Methods Open field validation blast tests were conducted with BTD and ABTD placed at matching locations. Tests at seven blast strength levels were completed spanning the range of overpressures for occupational testing. Results The two devices produced very similar values for lung injury dose over all blast levels and orientations. Conclusion The ABTD was validated successfully for open field tests. For occupational blast injury assessments, ABTD can be used in place of the BTD and provide enhanced capabilities.

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