scholarly journals The Use Extracorporeal Membrane Oxygenation Therapy in a Severe Blunt Chest Trauma with a Main Tracheal Injury

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Zhang J ◽  
◽  
Han H ◽  
Liu H ◽  
Li Y ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Extracorporeal Membrane Oxygenation ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Main Bronchus ◽  
Tension Pneumothorax ◽  
Trauma Patients ◽  
Left Main ◽  
Membrane Oxygenation ◽  
Vv Ecmo

Major tracheobronchial trauma by blunt chest trauma is high mortality rates worldwide. The use conventional mechanical ventilation in a tension pneumothorax patient by major tracheobronchial trauma has been ineffective with barotrauma. However, the application of Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) in trauma patients has been controversial, but VV-ECMO plays a crucial role when conventional management has failed. VV-ECMO provides adequate tissue oxygenation and an opportunity for recovery. Neither ECMO-associated bleeding nor clotting of the extracorporeal circuit is an upmost for trauma patients. We report a case of previously healthy 16-year-old man with left main bronchial rupture after vehicular accident, who had progressive dyspnea and left tension pneumothorax. After the chest tube drainage, double-lumen endotracheal intubation and mechanical ventilation initiation, severe respiratory distress kept on deterioration. On VV-ECMO transfer to our hospital, we performed emergency thoracotomy and identified the rupture of the left main bronchus. After operation, the patient’s condition improved. VV-ECMO and mechanical ventilation were stopped on days 8 and 9, respectively. He was discharged without complications from the ICU on day 20.

Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support

Perfusion ◽  
2021 ◽  
pp. 026765912110128
Author(s):  
Ismael A Salas De Armas ◽  
Bindu Akkanti ◽  
Pratik B Doshi ◽  
Manish Patel ◽  
Sachin Kumar ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Injury Severity ◽  
Invasive Mechanical Ventilation ◽  
Ecmo Support ◽  
Trauma Patients ◽  
Membrane Oxygenation ◽  
Trauma Service ◽  
Proper Patient Selection ◽  
Vv Ecmo

Background: Respiratory failure (RF) is a common cause of death and morbid complication in trauma patients. Extracorporeal membrane oxygenation (ECMO) is increasingly used in adults with RF refractory to invasive mechanical ventilation. However, use of ECMO remains limited for this patient population as they often have contraindications for anticoagulation. Study design: Medical records were retroactively searched for all adult patients who were admitted to the trauma service and received veno-venous ECMO (VV ECMO) support between June 2015 and August 2018. Survival to discharge and ECMO-related complications were collected and analyzed. Results: Fifteen patients from a large Level I trauma center met the criteria. The median PaO2/FiO2 ratio was 53.0 (IQR, 27.0–76.0), median injury severity score was 34.0 (IQR, 27.0–43.0), and the median duration of ECMO support was 11 days (IQR, 7.5–20.0). For this cohort, the survival-to-discharge rate was 87% (13/15). The incidence of neurologic complications was 13%, and deep vein thrombosis was reported in two cases (13%). Conclusions: Survival rates of trauma patients in this study are equivalent to, or may exceed, those of non-trauma patients who receive ECMO support for other types of RF. With the employment of a multidisciplinary team assessment and proper patient selection, early cannulation, traumatic RF may be safely supported with VV ECMO in experienced centers.

scholarly journals Right main bronchus rupture associated with blunt chest trauma: a case report

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Carime Díaz ◽  
Daniel F. Carvajal ◽  
Eliana I. Morales ◽  
Saveria Sangiovanni ◽  
Liliana Fernández-Trujillo
Keyword(s):  
Emergency Department ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Main Bronchus ◽  
Tension Pneumothorax ◽  
Fiberoptic Bronchoscopy ◽  
Signs And Symptoms ◽  
Pulmonary Contusion ◽  
Delay In Diagnosis ◽  
Airway Injury

Abstract Background Tracheobronchial injury is one of the least common injuries in the scenario of blunt chest trauma. However, around 81% of patients with airway injury die immediately or before arriving at the emergency department due to tension pneumothorax. It presents with non-specific signs and symptoms challenging prompt diagnosis. Case presentation A 15-year-old adolescent who was riding a bicycle suffered an accident when he fell down a cliff, approximately 5 m deep. Upon admission to the emergency department, he presented with signs of respiratory distress. The airway was secured and a thoracoabdominal angiography was performed. The image reported pneumomediastinum, a small right pneumothorax, areas of pulmonary contusion, and an image of loss of continuity in the anterior superior wall of the right main bronchus highly suggestive of bronchial rupture. The bronchial lesion was then confirmed by fiberoptic bronchoscopy. Taking into account the patient’s characteristics, conservative management was chosen, and the patient was transferred to the intensive care unit (ICU) where protective tracheal intubation was performed. Conclusions A delay in diagnosis increases the rate of complications, mainly infectious complications and the formation of granulation tissue that could potentially obstruct the airway, impacting the patient’s outcome. The first step in the management of these patients is securing the airway, which should be done immediately. The gold standard for the diagnosis and characterization of airway injuries is bronchoscopy as it is the most effective tool to assess topography, extent, and depth of the lesion.

Does Earlier Cannulation With Veno-Venous Extracorporeal Membrane Oxygenation in Adult Patients With Acute Respiratory Distress Syndrome Decrease Duration of Artificial Mechanical Ventilation?

2020 ◽  
Vol 13 (2) ◽  
pp. 148-155
Author(s):  
Christine Hartner ◽  
Jacqueline Ochsenreither ◽  
Kenneth Miller ◽  
Michael Weiss
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Lung Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Adult Patients ◽  
Membrane Oxygenation ◽  
Vv Ecmo

BackgroundAcute respiratory distress syndrome (ARDS) is characterized by an acute, diffuse, inflammatory lung injury, leading to increased alveolar capillary permeability, increased lung weight, and loss of aerated lung tissue (Fan, Brodie, & Slutsky, 2018). Primary treatment for ARDS is artificial mechanical ventilation (AMV) (Wu, Huang, Wu, Wang, & Lin, 2016). Given recent advances in technology, the use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) to treat severe ARDS is growing rapidly (Combes et al., 2014).ObjectiveThis 49-month quantitative, retrospective inpatient EMR chart review compared if cannulation with VV-ECMO up to and including 48 hours of admission and diagnosis in adult patients 30 to 65 years of age diagnosed with ARDS, decreased duration on AMV, as compared to participants who were cannulated after 48 hours of admission and diagnosis with ARDS.MethodsA total of 110 participants were identified as receiving VV-ECMO during the study timeframe. Of the 58 participants who met all inclusion criteria, 39 participants were cannulated for VV-ECMO within 48 hours of admission and diagnosis with ARDS, and 19 participants were cannulated with VV-ECMO after 48 hours of admission and diagnosis with ARDS.ResultsData collected identified no statistically significant (p < 0.579) difference in length of days on AMV between participant groups.ConclusionsFurther studies are needed to determine if earlier initiation of VV-ECMO in adult patients with ARDS decrease time on AMV.Implications for NursingAlthough the results related to length of time on AMV did not produce statistical significance, the decreased duration of AMV in the participants who were cannulated within 48 hours (21 days vs. 27 days) may support several benefits associated with this participant population including increased knowledge of healthcare providers, decreased lung injury, earlier discharge which decreases hospital and patient cost, ability for patients to communicate sooner, decreased risk of pulmonary infection, decreased length of stay, decreased cost, and improved patient and family satisfaction.

Combined ascending aorta rupture and left main bronchus disruption from blunt chest trauma

1989 ◽  
Vol 47 (5) ◽  
pp. 769-771 ◽  
Author(s):  
J. Marzelle ◽  
R. Nottin ◽  
Ph. Dartevelle ◽  
F.Lacour Gayet ◽  
M. Navajas ◽  
...  
Keyword(s):  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Main Bronchus ◽  
Ascending Aorta ◽  
Left Main Bronchus ◽  
Left Main ◽  
Aorta Rupture

scholarly journals Conservative management of Occult Hemothorax in trauma patients requiring assisted ventilation: An observational descriptive study

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Ismail Mahmood ◽  
Khalid Ahmed ◽  
Fuad Mustafa ◽  
Zahoor Ahmed ◽  
Syed Nabir ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Conservative Management ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Assisted Ventilation ◽  
Tube Thoracostomy ◽  
Trauma Patients ◽  
Respiratory Compromise ◽  
Mechanically Ventilated

Background: Traumatic hemothorax is a common consequence of blunt chest trauma. A hemothorax that is missed by initial chest X-ray, but diagnosed by computed tomography (CT), is known as an occult hemothorax. The present study aims at investigating the clinical outcomes of conservative management of occult hemothorax in mechanically ventilated trauma patients. Methods: A retrospective study of all adult blunt chest trauma patients with occult hemothorax requiring mechanical ventilation in a level 1 trauma center was conducted (2010- 2017). Data were obtained from the trauma registry and electronic medical records. Patients were categorized into (a) successful conservative treatment group, and (b) tube thoracostomy group. Results: During the study period, 78 blunt chest trauma patients who had occult hemothorax required mechanical ventilation. Occult hemothorax was managed conservatively in 69% of the patients, while 31% underwent tube thoracostomy. The main indication for tube thoracostomy was the progression of hemothorax on follow-up chest radiographs. Comparison between groups showed that pulmonary contusions (59% vs. 83%), bilateral hemothorax (26% vs. 58%) and chest infections (9% vs. 29%) were lower in conservatively treated group (p < 0.05). Length of stays in ICU and hospital were also lower (p < 0.05). Longer duration of mechanical ventilation and maximum PEEP were significantly associated with tube thoracostomy. Overall mortality was 12% and was comparable between groups. Conclusion: Mechanically ventilated patients with occult hemothorax following blunt chest trauma can be managed conservatively without tube thoracostomy. Tube thoracostomy can be restricted to patients who had evidence of progression of hemothorax on follow-up or developed respiratory compromise.

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