Pneumothorax and Subcutaneous Emphysema Evaluation in Patients with COVID-19 in the Intensive Care Unit

Abstract Background Pneumocephalus and pneumorachis, presence of air inside the skull and spinal canal, are mostly seen after neurosurgical procedures and neuraxial anesthesia. They have also been described after penetrating trauma, but never after blunt trauma without adjacent bone fractures. Case description We present the case of an 85-year-old white male patient admitted to our intensive care unit after a high velocity car accident. On site clinical evaluation showed normal consciousness with 15/15 Glasgow Coma Scale after a short initial loss of consciousness. The patient was first sent to a nearby hospital where a whole-body computed tomography scan revealed pneumocephalus and pneumorachis and an important left hemopneumothorax with pneumomediastinum with extensive subcutaneous emphysema. The state of the patient quickly worsened with hemorrhagic shock. The patient was sent to our intensive care unit; upon neurosurgical evaluation, no surgical indication was retained due to the absence of skull and spine fracture. A computed tomography scan performed on day 6 showed total regression of the pneumocephalus and pneumorachis. A follow-up computed tomography scan performed on day 30 revealed no intracranial bleeding or stroke, but a left pleural hernia between ribs 5 and 6. Due to respiratory complications, our patient could not be weaned from ventilator support for a proper neurological examination. Our patient’s state finally worsened with septic shock due to ventilator-acquired pneumonia leading to multiple organ failure and our patient died on day 37. Conclusions This is the first case report to describe pneumorachis and pneumocephalus following blunt trauma with pneumothorax, but no spinal or skull fractures. The mechanism that is probably involved here is a migration of air with subcutaneous emphysema and a pleural hernia into the spinal canal. However, in cases of pneumorachis or pneumocephalus, skull fractures need to be investigated as these require surgery and appropriate vaccination to prevent meningitis.

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Rapid resolution of severe subcutaneous emphysema causing respiratory failure with subcutaneous drain

SAGE Open Medical Case Reports ◽

10.1177/2050313x21997196 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2199719

Author(s):

Ala Mustafa ◽

Caio Heleno ◽

Douglas T Summerfield

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Respiratory Distress ◽

Critically Ill ◽

Subcutaneous Emphysema ◽

Case Reports ◽

Definitive Treatment ◽

Critically Ill Patient ◽

Rapid Resolution

This case reports on a critically ill patient (Male, 74) with severe subcutaneous emphysema which progressed to causing respiratory distress. We document both the severity of the condition we observed and then present a novel intervention. In this case, we decompressed the patient at the intensive care unit-bedside and resolved the condition. While subcutaneous emphysema is relatively common, the severity of the condition we observed, and the lack of definitive treatment guidance have prompted us to present this case as a plausible treatment guide.

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COVID-19 with spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema in the intensive care unit: two case reports

Journal of Infection and Public Health ◽

10.1016/j.jiph.2020.12.019 ◽

2020 ◽

Author(s):

Abdulrahman Alharthy ◽

Gultakin H. Bakirova ◽

Homaida Bakheet ◽

Abdullah Balhamar ◽

Peter G. Brindley ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Subcutaneous Emphysema ◽

Spontaneous Pneumothorax ◽

Case Reports

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Demystifying subcutaneous emphysema in intensive care unit

Airway ◽

10.4103/arwy.arwy_40_20 ◽

2020 ◽

Vol 3 (3) ◽

pp. 157

Author(s):

Swati Jindal ◽

Sarabjeet Chhabra

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Subcutaneous Emphysema

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Subcutaneous emphysema and pneumomediastinum after endoscopic transnasal removal of nasopharyngeal angiofibroma

Head and neck tumors (HNT) ◽

10.17650/2222-1468-2021-11-2-57-63 ◽

2021 ◽

Vol 11 (2) ◽

pp. 57-63

Author(s):

M. S. Kuznetsov ◽

A. V. Voronov ◽

V. V. Dvoryanchikov ◽

D. V. Svistov ◽

A. I. Nikitin

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Intensive Care ◽

Conservative Treatment ◽

Subcutaneous Emphysema ◽

Subcutaneous Fat ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Endoscopic Endonasal ◽

Nasopharyngeal Angiofibroma ◽

Antiinflammatory Therapy

Introduction. Juvenile nasopharyngeal angiofibroma is a rare, benign, well-vascularized tumor of the skull base characterized by destructive growth. The development of endoscopic techniques and experience of surgeons have enabled the removal of this tumor both at early stages and late stages (advanced disease). Patients may develop various complications in the intraoperative and postoperative periods, including massive bleeding, nasal liquorrhea, facial paresthesia, lacrimal hyposecretion, etc. Air penetration into the subcutaneous fat and mediastinum during endoscopic surgery on the paranasal sinuses is rare. Such complication as subcutaneous emphysema and pneumomediastinum after endoscopic endonasal removal of juvenile nasopharyngeal angiofibroma has not been reported in the literature.Case report. A 19-year-old male patient has undergone endoscopic endonasal removal of juvenile nasopharyngeal angiofibroma. The tamponade was removed within the first 24 h postoperatively. Ten hours after it, the patient developed subcutaneous emphysema and pneumomediastinum triggered by sneezing. The diagnosis was confirmed by computed tomography of the neck and chest. The patient was transferred to the intensive care unit and received conservative treatment (including infusion, antibacterial, and antiinflammatory therapy). The symptoms of subcutaneous emphysema and pneumomediastinum subsided in response to treatment. Follow-up examinations (computed tomography and magnetic resonance imaging) confirmed that the tumor had been completely removed. The patient was discharged in a satisfactory condition.Conclusion. Subcutaneous emphysema and pneumomediastinum are exceedingly rare complications of endoscopic endonasal removal of juvenile nasopharyngeal angiofibroma and are caused by anatomical connection between the parapharyngeal / retropharyngeal spaces and mediastinum. To prevent such complications, it is necessary to keep tampons in the nasal cavity for at least 2 days, as well as to instruct patients after surgery (avoid sneezing with their mouth closed, lifting weights, coughing, and vomiting). The nasoseptal flap used to repair the nasopharyngeal defect after tumor removal also ensures its sealing. Patients with complications should undergo computed tomography of the neck and chest (in case of emergency) and should be transferred to an intensive care unit. Conservative treatment (antibacterial and antiinflammatory therapy) will ensure good results in most patients.

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The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00097 ◽

2019 ◽

Vol 4 (6) ◽

pp. 1507-1515

Author(s):

Lauren L. Madhoun ◽

Robert Dempster

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Hospital Discharge ◽

Neonatal Intensive Care ◽

Oral Feeding ◽

Medical Attention ◽

Primary Role ◽

Speech Language Pathologists ◽

The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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