Tracheal tube obstruction due to hemoptysis associated with pulmonary infarction in a patient with severe COVID-19 pneumonia: A case report.

Abstract Background: The incidence of thrombotic complications is extremely high among severe coronavirus disease 2019(COVID-19) patients in the intensive care unit. Various factors such as a cytokine storm due to an excessive immune response to inflammation, hypoxemia, and disseminated intravascular coagulation are considered predisposing factors for thrombotic complications.Case presentation: A 55-year-old Japanese man intubated 8 days previously was referred to our hospital because of a severe COVID-19 pneumonia diagnosis after his pharyngeal swab tested positive for severe acute respiratory syndrome coronavirus 2 using reverse transcription-polymerase chain reaction. The patient continued to remain hypoxic (PaO2/FiO2 ratio <100 mmHg) at the referring hospital. On admission, we initiated veno-venous extracorporeal membrane oxygenation (VV-ECMO). Unfractionated heparin and nafamostat mesylate were used as anticoagulants during VV-ECMO. Despite the adequate anticoagulant therapy, he developed pulmonary infarction due to pulmonary embolism followed by hemoptysis. On day 10 following admission, his oxygen saturation dropped from 95% to 88%, with a marked decrease in his ventilator tidal volume, accompanied by an inability to ventilate the patient. Thereafter, we increased the VV-ECMO flow and exchanged his endotracheal tube. The lumen of the removed tracheal tube was found to be occluded by a large-sized blood coagulum. There was no further episode of tube occlusion. The patient was discharged in a walkable state on day 39 following admission. Conclusions: Endotracheal tube obstruction secondary to hemoptysis should be suggested in patients with COVID-19 requiring ventilator support, as they are not able to perform frequent endotracheal tube suctions owing to the risk of infection.

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Tracheal Tube Obstruction Due to Hemoptysis Associated With Pulmonary Infarction in a Patient With Severe COVID-19 Pneumonia

Cureus ◽

10.7759/cureus.13599 ◽

2021 ◽

Author(s):

Takaaki Maruhashi ◽

Tatsuhiko Wada ◽

Tomonari Masuda ◽

Kunihiro Yamaoka ◽

Yasushi Asari

Keyword(s):

Tracheal Tube ◽

Pulmonary Infarction ◽

Tube Obstruction

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A rare cause of complete airway obstruction caused by a defective pilot tube of a reinforced endotracheal tube

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-019-0045-7 ◽

2019 ◽

Vol 11 (1) ◽

Author(s):

Rathna Paramaswamy

Keyword(s):

Airway Obstruction ◽

Endotracheal Tube ◽

Critical Incident ◽

Tension Pneumothorax ◽

Case Presentation ◽

Tube Obstruction ◽

Pilot Balloon ◽

Common Causes ◽

The Common ◽

Tracheal Cuff

Abstract Background The common causes of failure to inflate the lungs after placement of an endotracheal tube include mechanical obstruction of the tube by tight gauzes, tongue blade, tube kinking, patient biting on the tube, obstruction of the lumen by blood or foreign body, bronchospasm, haemothorax, tension pneumothorax or equipment malfunction. Case presentation We report a case of complete airway obstruction due to herniation of the pilot inflation line into the lumen at the proximal end of a reinforced tube when the tracheal cuff was inflated. Prior to use, the endotracheal tube was tested and functioned normally. The patient was uneventfully reintubated with a new endotracheal tube. With the endotracheal tube, device problems often involve the pilot balloon and cuff assembly and leaks are more common. Conclusion This case report highlights an unusual cause of complete proximal lumen obstruction due to a manufacturing defect which could have caused a critical incident in the theatre.

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Septic shock due to Yersinia pseudotuberculosis infection in an adult immunocompetent patient: a case report and literature review

BMC Infectious Diseases ◽

10.1186/s12879-020-05733-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Takehiro Hashimoto ◽

Ryuichi Takenaka ◽

Haruka Fukuda ◽

Kazuhiko Hashinaga ◽

Shin-ichi Nureki ◽

...

Keyword(s):

Septic Shock ◽

Therapeutic Strategy ◽

Yersinia Pseudotuberculosis ◽

Immunocompromised Host ◽

Immunocompetent Patient ◽

Case Presentation ◽

Gram Negative ◽

Old Japanese ◽

The Right ◽

Immunocompetent Patients

Abstract Background Yersinia pseudotuberculosis infection can occur in an immunocompromised host. Although rare, bacteremia due to Y. pseudotuberculosis may also occur in immunocompetent hosts. The prognosis and therapeutic strategy, especially for immunocompetent patients with Y. pseudotuberculosis bacteremia, however, remains unknown. Case presentation A 38-year-old Japanese man with a mood disorder presented to our hospital with fever and diarrhea. Chest computed tomography revealed consolidation in the right upper lobe with air bronchograms. He was diagnosed with pneumonia, and treatment with intravenous ceftriaxone and azithromycin was initiated. The ceftriaxone was replaced with doripenem and the azithromycin was discontinued following the detection of Gram-negative rod bacteria in 2 sets of blood culture tests. The isolated Gram-negative rod bacteria were confirmed to be Y. pseudotuberculosis. Thereafter, he developed septic shock. Doripenem was switched to cefmetazole, which was continued for 14 days. He recovered without relapse. Conclusions We herein report a case of septic shock due to Y. pseudotuberculosis infection in an adult immunocompetent patient. The appropriate microorganism tests and antibiotic therapy are necessary to treat patients with Y. pseudotuberculosis bacteremia.

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Tracheal Tube Obstruction Assessed by Computed Tomography

Anesthesiology ◽

10.1097/aln.0000000000000677 ◽

2015 ◽

Vol 123 (1) ◽

pp. 236-237

Author(s):

Marcus J. Schultz

Keyword(s):

Computed Tomography ◽

Tracheal Tube ◽

Tube Obstruction

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Falsely diagnosed thyrotoxicosis caused by anti-streptavidin antibodies and pre-wash procedures

Thyroid Research ◽

10.1186/s13044-021-00108-y ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Takuya Ishikawa ◽

Hiroyuki Sakai ◽

Tokutaro Itaya ◽

Suwanai Hirotsugu ◽

Jumpei Shikuma ◽

...

Keyword(s):

Thyroid Function ◽

Magnetic Particle ◽

Thyroid Function Tests ◽

Case Presentation ◽

Analytical Interference ◽

Function Tests ◽

Inappropriate Treatment ◽

Published Report ◽

Old Japanese ◽

Polyethylene Glycol Precipitation

Abstract Background Anti-streptavidin antibodies are causal determinants of analytical interference during Thyroid function tests, and numerous reports have detailed such interference, with anti-streptavidin antibodies attracting attention. Case presentation We conducted a straightforward investigation of interference due to anti-streptavidin antibodies, with a case of a 60-year-old Japanese man who consulted our department for inconsistencies between his clinical course and Thyroid function tests. Experiments were conducted using Cobas8000 e602, which employs assay procedures with pre-wash to evaluate FT4 and FT3 levels. Conclusions To our knowledge, this is the first published report to clearly investigate such interferences using a combination of polyethylene glycol precipitation, heterophilic blocking tube precipitation, streptavidin-coated magnetic particle precipitation, and different instruments with or without pre-wash. Clinicians should consider that interferences caused by anti-streptavidin antibodies could lead to a misdiagnosis of thyrotoxicosis. Moreover, discussions between laboratory specialists, clinicians, and manufacturers are required to identify interferences and avoid unnecessary examinations and inappropriate treatment.

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Complete endotracheal tube obstruction after nasotracheal intubation

Canadian Anaesthetists Society journal / Journal de la Société canadienne des anesthésistes ◽

10.1007/bf03007906 ◽

1984 ◽

Vol 31 (3) ◽

pp. 344-345 ◽

Cited By ~ 2

Author(s):

Takahisa Mayumi ◽

Dai Horikawa ◽

Masayuki Miyabe ◽

Shuji Dohi

Keyword(s):

Endotracheal Tube ◽

Nasotracheal Intubation ◽

Tube Obstruction

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Risk factors and prognosis of nosocomial pneumonia in patients undergoing extracorporeal membrane oxygenation: a retrospective study

Journal of International Medical Research ◽

10.1177/0300060520964701 ◽

2020 ◽

Vol 48 (10) ◽

pp. 030006052096470

Author(s):

Jianrong Wang ◽

Jinyu Huang ◽

Wei Hu ◽

Xueying Cai ◽

Weihang Hu ◽

...

Keyword(s):

Risk Factors ◽

Extracorporeal Membrane Oxygenation ◽

Nosocomial Pneumonia ◽

Discharge Rate ◽

Multivariable Analysis ◽

Ventilator Support ◽

Membrane Oxygenation ◽

Independent Risk Factors ◽

Medical University ◽

Vv Ecmo

Objective We aimed to examine the risk factors and prognosis of nosocomial pneumonia (NP) during extracorporeal membrane oxygenation (ECMO). Methods We retrospectively analyzed data of patients who received ECMO at the Affiliated Hangzhou Hospital of Nanjing Medical University between January 2013 and August 2019. The primary outcome was the survival-to-discharge rate. Results Sixty-nine patients who received ECMO were enrolled, median age 42 years and 26 (37.7%) women; 14 (20.3%) patients developed NP. The NP incidence was 24.7/1000 ECMO days. Patients with NP had a higher proportion receiving veno-venous (VV) ECMO (50% vs. 7.3%); longer ECMO support duration (276 vs. 140 hours), longer ventilator support duration before ECMO weaning (14.5 vs. 6 days), lower ECMO weaning success rate (50.0% vs. 81.8%), and lower survival-to-discharge rate (28.6% vs. 72.7%) than patients without NP. Multivariable analysis showed independent risk factors that predicted NP during ECMO were ventilator support duration before ECMO weaning (odds ratio [OR] = 1.288; 95% confidence interval [CI]: 1.111–1.494) and VV ECMO mode (OR = 10.970; 95% CI: 1.758–68.467). Conclusion NP during ECMO was associated with ventilator support duration before ECMO weaning and VV ECMO mode. Clinicians should shorten the respiratory support duration for patients undergoing ECMO to prevent NP.

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