scholarly journals Salvage Treatment of Acute Respiratory Failure after Transcomposite Myocutaneous Flaps Transplantation for Chronic Empyema Combined with Chest wall sinus: A Case Report

Author(s):  
Lei Wang ◽  
Zhongliang He

Abstract BackgroundChronic empyema with chest wall sinus is a complex and refractory disease caused by multiple factors.It may be combined with bronchopleural fistula, residual bone and other necrotic tissue,causing local infection difficult to control, and the disease is a vicious circle.Case presentationThis paper reports a 62-year-old male patient who underwent right pneumonectomy for squamous cell carcinoma of the lung 11 years ago and began to develop empyema with purulent sinus in the anterior chest wall 3 years ago. Therefore, he was admitted to our medical center for further treatment. Chest computed tomography (CT) showed the right pleural effusion with the chest wall rupture sinus. According to his clinical symptoms and imaging examination, he was diagnosed as chronic empyema with chest wall sinus.Due to the large empyema cavity,the patient should be treated with free vastus lateralis musculocutaneous flap combined with pedicled pectoralis major muscle flap transplantation.After the operation, acute respiratory failure occurred due to left lung aspiration pneumonia.ConclusionsAfter a series of treatment measures such as tracheal intubation, tracheotomy, anti-infection, maintenance of circulatory stability, and rehabilitation training, he was finally rescued and cured.Follow-up after discharge showed that the tissue flap survived and empyema was eliminated.

2021 ◽  
Author(s):  
Lei Wang ◽  
Zhongliang He

Abstract BackgroundChronic empyema with chest wall sinus is a complex and refractory disease caused by multiple factors.It may be combined with bronchopleural fistula, residual bone and other necrotic tissue,causing local infection difficult to control, and the disease is a vicious circle.Case presentationThis paper reports a 62-year-old male patient who underwent right pneumonectomy for squamous cell carcinoma of the lung 11 years ago and began to develop empyema with purulent sinus in the anterior chest wall 3 years ago. Therefore, he was admitted to our medical center for further treatment. Chest computed tomography (CT) showed the right pleural effusion with the chest wall rupture sinus. According to his clinical symptoms and imaging examination, he was diagnosed as chronic empyema with chest wall sinus.Due to the large empyema cavity,the patient should be treated with free vastus lateralis musculocutaneous flap combined with pedicled pectoralis major muscle flap transplantation.After the operation, acute respiratory failure occurred due to left lung aspiration pneumonia.ConclusionsAfter a series of treatment measures such as tracheal intubation, tracheotomy, anti-infection, maintenance of circulatory stability, and rehabilitation training, he was finally rescued and cured.Follow-up after discharge showed that the tissue flap survived and empyema was eliminated.


2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yongyong Wu ◽  
Zhongliang He ◽  
Weihua Xu ◽  
Guoxing Chen ◽  
Zhijun Liu ◽  
...  

Abstract Background Bronchopleural fistula (BPF) refers to an abnormal channel between the pleural space and the bronchial tree. It is a potentially fatal postoperative complication after pulmonary resection and a complex challenge for thoracic surgeons because many patients with BPF ultimately develop refractory empyema, which is difficult to manage and has a major impact on quality of life and survival. Therefore, an operative intervention combined with conservative and endoscopic therapies may be required to control infection completely, to occlude BPF, and to obliterate the empyema cavity during treatment periods. Case presentation Two patients who suffered from BPF complicated with chronic empyema after lobectomy were treated in other hospitals for a long time and did not recover. In our department, we performed staged surgery and creatively combined an Amplatzer Septal Occluder (ASO) device (AGA Medical Corp, Golden Valley, MN, USA) with pedicled muscle flap transposition. First, open-window thoracostomy (OWT), or effective drainage, was performed according to the degree of contamination in the empyema cavity after the local infection was controlled. Second, Amplatzer device implantation and pedicled muscle flap transposition was performed at the same time, which achieved the purpose of obliterating the infection, closing the fistula, and tamponading the residual cavity. The patients recovered without complications and were discharged with short hospitalization stays. Conclusions We believe that the union of the Amplatzer device and pedicle muscle flap transposition seems to be a safe and effective treatment for BPF with chronic empyema and can shorten the length of the related hospital stay.


2021 ◽  
Vol 8 ◽  
Author(s):  
Rongjun Wan ◽  
Wenzhe Yang ◽  
Xinhua Ma ◽  
Wei Yang ◽  
Pinhua Pan ◽  
...  

Granulomatosis with polyangiitis (GPA) is a subtype of anti-neutrophil cytoplasmic antibody-associated vasculitis with a wide range of clinical symptoms related to the systemic involvement of small blood vessels. The respiratory system is one of the most frequently involved, and life-threatening acute respiratory failure could occur due to diffusive alveolar hemorrhage and tracheal stenosis. When maximum mechanical ventilation is unable to maintain oxygenation, extracorporeal membrane oxygenation (ECMO) should be considered as the final respiratory supportive method, if available. Here we present a 32-year-old male patient with acute respiratory failure (ARF) related to GPA, who was rescued by winning time for accurate diagnosis and appropriate treatment. Additionally, we reviewed more than 60 GPA-related ARF cases on multiple online databases, summarized the clinical manifestations of these patients, and concluded that ECMO plays an important role in further respiratory support for ARF patients with GPA and assists in accurate and timely diagnosis and appropriate treatment, thus helping them recuperate.


2021 ◽  
Vol 11 (1) ◽  
pp. 3-9
Author(s):  
Karolina Dolezalova ◽  
Cabelova Tamara ◽  
Tomas Hecht ◽  
Pavel Heinige

The authors present a case report of an otherwise healthy, fully immunized 12-year-old girl who had a critical course of COVID-19 infection with acute respiratory failure. The epidemiologic history was positive for COVID-19, and she tested PCR positive resulting from a nasopharyngeal swab. She was presented with fever and cough to a regional pediatric department, and she was immediately intubated and transferred to a pediatric ICU in a University Hospital. CT of the thorax revealed bilateral consolidation with the tree-in-bud signs. Her condition required artificial ventilation support for 13 days. Remdesivir, pronation, high dose Ascorbic acid with Thiamine, and combined antimicrobial therapy were successfully used. The patient made a full clinical recovery. This case report is unique because of a very scarce critical course of COVID-19 infection in children. It demonstrates the successful use of a combined therapeutic approach with artificial ventilation, pronation, Remdesivir, and combined antimicrobial therapy. Clinical symptoms, laboratory results, imaging methods, and therapeutic attitude are mentioned to share our experience with the medical community.


CHEST Journal ◽  
1982 ◽  
Vol 82 (2) ◽  
pp. 202
Author(s):  
Jeffrey A. Katz ◽  
H. Barrie Fairley ◽  
Gerard M. Ozanne ◽  
Steven E. Zinn

2020 ◽  
Vol 14 ◽  
pp. 175346662092695
Author(s):  
Wei-Ling Lain ◽  
Shi-Chuan Chang ◽  
Wei-Chih Chen

Background: There are few studies reporting the clinical characteristics and outcomes of interstitial lung disease (ILD) patients with acute respiratory failure (ARF). The goal of this study is to investigate the clinical features, management, mortality, and associated factors in ILD patients with ARF requiring mechanical ventilation (MV). Methods: This was a retrospective, observational study conducted in a 24-bed intensive care unit (ICU) of a medical center in Taiwan during a 3-year period. Patients admitted to the ICU with a diagnosis of ILD with ARF needing MV were included for analysis. Patient characteristics, including demographics, critical-illness factors, and outcome data, were collected and analyzed. Results: A total of 82 patients with ILD who developed ARF were admitted to the ICU during the study period. At the onset of ARF, 38 patients received invasive MV, while 44 patients were treated with noninvasive MV. Overall in-hospital mortality was 65.9%, and 90-day and 1-year mortality were 69.5% and 76.8%, respectively. The independent risk factors for in-hospital mortality were worse oxygenation on days 5 and 7 after the onset of ARF. Invasive MV patients had significantly lower albumin levels, had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores at the onset of ARF, and received more vasopressors, sedatives, and corticosteroid pulse therapy during hospitalization compared with noninvasive MV patients. Conclusion: High in-hospital and long-term mortality rates were observed in ILD patients with ARF requiring MV. Poor oxygenation during hospitalization could serve as a predictive factor of poor prognosis. The reviews of this paper are available via the supplemental material section.


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