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Case Report
Pulmonary
Negative Pressure Pulmonary Hemorrhage after Laryngospasm during the Postoperative Period
In Soo Han, Bo Mi Han, Soo Yeon Jung, Jun Rho Yoon, Eun Yong Chung
Acute Crit Care. 2018;33(3):191-195.   Published online August 31, 2018
DOI: https://doi.org/10.4266/acc.2016.00689
  • 6,232 View
  • 166 Download
  • 5 Web of Science
  • 5 Crossref
AbstractAbstract PDF
Negative pressure pulmonary hemorrhage (NPPH) is an uncommon complication of upper airway obstruction. Severe negative intrathoracic pressure after upper airway obstruction can increase pulmonary capillary mural pressure, which results in mechanical stress on the pulmonary capillaries, causing NPPH. We report a case of acute NPPH caused by laryngospasm in a 25-year-old man during the postoperative period. Causative factors of NPPH include negative pulmonary pressure, allergic rhinitis, smoking, inhaled anesthetics, and positive airway pressure due to coughing. The patient’s symptoms resolved rapidly, within 24 hours, with supportive care.

Citations

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  • A Complex Presentation of Acute Postoperative Negative-Pressure Pulmonary Edema: A Case Report and Review of Literature
    Larri Rudman, Javier B Chambi-Torres, Farah Chohan, Mohammad Aftab, Xinyu Cao, George Michel
    Cureus.2023;[Epub]     CrossRef
  • Laryngospasm Causing Recurrent Negative Pressure Alveolar Hemorrhage Resembling Acute Exacerbation of Interstitial Lung Disease: A Case Report
    Haruna Yamaki, Masaru Ejima, Nozomi Sato, Kei Aoyagi, Tatsushi Kozawa, Seishi Higashi, Koji Takayama, Satoko Hanada, Reiko Taki
    Respiratory Endoscopy.2023; 1(2): 95.     CrossRef
  • Unilateral pulmonary hemorrhage caused by negative pressure pulmonary edema: A case report
    Hyung Joon Park, Seung Ho Park, Un Tak Woo, Sang Yun Cho, Woo Jae Jeon, Woo Jong Shin
    World Journal of Clinical Cases.2021; 9(6): 1408.     CrossRef
  • Negative-pressure-related diffuse alveolar hemorrhage after monitored anesthesia care for vertebroplasty: a case report
    Yumin Jo, Jagyung Hwang, Jieun Lee, Hansol Kang, Boohwi Hong
    Journal of Medical Case Reports.2021;[Epub]     CrossRef
  • Incidence of negative-pressure pulmonary edema following sugammadex administration during anesthesia emergence: A pilot audit of 27,498 general anesthesia patients and literature review
    Chia-Li Kao, Chuan-Yi Kuo, Yi-Kai Su, Kuo-Chuan Hung
    Journal of Clinical Anesthesia.2020; 62: 109728.     CrossRef
Original Article
Pulmonary
Evaluation of Respiratory Dynamics in an Asymmetric Lung Compliance Model
So Hui Yun, Ho-Jin Lee, Yong-Hun Lee, Jong Cook Park
Korean J Crit Care Med. 2017;32(2):174-181.   Published online April 14, 2017
DOI: https://doi.org/10.4266/kjccm.2016.00738
  • 6,493 View
  • 95 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Background
Unilateral lung hyperinflation develops in lungs with asymmetric compliance, which can lead to vital instability. The aim of this study was to investigate the respiratory dynamics and the effect of airway diameter on the distribution of tidal volume during mechanical ventilation in a lung model with asymmetric compliance.
Methods
Three groups of lung models were designed to simulate lungs with a symmetric and asymmetric compliance. The lung model was composed of two test lungs, lung1 and lung2. The static compliance of lung1 in C15, C60, and C120 groups was manipulated to be 15, 60, and 120 mL/cmH2O, respectively. Meanwhile, the static compliance of lung2 was fixed at 60 mL/cmH2O. Respiratory variables were measured above (proximal measurement) and below (distal measurement) the model trachea. The lung model was mechanically ventilated, and the airway internal diameter (ID) was changed from 3 to 8 mm in 1-mm increments.
Results
The mean ± standard deviation ratio of volumes distributed to each lung (VL1/VL2) in airway ID 3, 4, 5, 6, 7, and 8 were in order, 0.10 ± 0.05, 0.11 ± 0.03, 0.12 ± 0.02, 0.12 ± 0.02, 0.12 ± 0.02, and 0.12 ± 0.02 in the C15 group; 1.05 ± 0.16, 1.01 ± 0.09, 1.00 ± 0.07, 0.97 ± 0.09, 0.96 ± 0.06, and 0.97 ± 0.08 in the C60 group; and 1.46 ± 0.18, 3.06 ± 0.41, 3.72 ± 0.37, 3.78 ± 0.47, 3.77 ± 0.45, and 3.78 ± 0.60 in the C120 group. The positive end-expiratory pressure (PEEP) of lung1 was significantly increased at airway ID 3 mm (1.65 cmH2O) in the C15 group; at ID 3, 4, and 5 mm (2.21, 1.06, 0.95 cmH2O) in the C60 group; and ID 3, 4, and 5 mm (2.92, 1.84, 1.41 cmH2O) in the C120 group, compared to ID 8 mm (p < 0.05).
Conclusions
In the C15 and C120 groups, the tidal volume was unevenly distributed to both lungs in a positive relationship with lung compliance. In the C120 group, the uneven distribution of tidal volume was improved when the airway ID was equal to or less than 4 mm, but a significant increase of PEEP was observed.

Citations

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  • Proof-of-concept study of compartmentalized lung ventilation using system for asymmetric flow regulation (SAFR)
    Igor Barjaktarevic, Glen Meyerowitz, Onike Williams, I. Obi Emeruwa, Nir Hoftman
    Frontiers in Medical Technology.2023;[Epub]     CrossRef
  • Is It Essential to Consider Respiratory Dynamics?
    Youngjoon Kang
    The Korean Journal of Critical Care Medicine.2017; 32(2): 223.     CrossRef
Case Reports
Pulmonary
A Reinforced Endotracheal Tube Completely Severed by a Patient Bite and Lodged in the Right Main Bronchus
Susie Yoon, Hyunjung Choo, Se Eun Kim, Heeyeon Kwon, Hannah Lee
Korean J Crit Care Med. 2017;32(1):70-73.   Published online November 14, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00437
  • 10,204 View
  • 148 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Reinforced endotracheal tubes (ETTs) are designed to resist kinking or compression. However, these have a potential risk of being obstructed or severed by a patient’s bite. We report a case in which a reinforced ETT was severed by tube-bite while the patient was in the prone position during an intensive care unit stay. Bronchoscopic evaluation showed that the severed distal part of the tube had lodged in the patient’s right main bronchus, and it had to be surgically removed. The patency of reinforced ETTs should be carefully monitored in patients intubated in the prone position.

Citations

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  • Anaesthesia for reconstructive free flap surgery for head and neck cancer
    Peter McCauley, Michael Moore, Edel Duggan
    British Journal of Hospital Medicine.2022; 83(5): 1.     CrossRef
  • Endotracheal Tube Obstruction Among Patients Mechanically Ventilated for ARDS Due to COVID-19: A Case Series
    Samuel Wiles, Eduardo Mireles-Cabodevila, Scott Neuhofs, Sanjay Mukhopadhyay, Jordan P. Reynolds, Umur Hatipoğlu
    Journal of Intensive Care Medicine.2021; 36(5): 604.     CrossRef
  • Complete Endotracheal Tube Transection by Patient Bite: A Case Report and Algorithm for Fragment Identification and Extraction
    Annette Ilg, Matthias Eikermann, Andrew J. Synn
    A&A Practice.2021; 15(3): e01428.     CrossRef
  • Importance of Capnography Monitoring in Critical Ill Patients
    Young-Kown Ko
    The Korean Journal of Critical Care Medicine.2017; 32(1): 79.     CrossRef
Pulmonary
Barotrauma after Manual Ventilation in a Patient with Life-Threatening Massive Hemoptysis
Hea Yon Lee, Yu Young Joo, Young Seung Oh, Yoo Rim Seo, Hyon Soo Joo, Seok Chan Kim, Chin Kook Rhee
Korean J Crit Care Med. 2015;30(4):308-312.   Published online November 30, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.4.308
  • 8,023 View
  • 110 Download
  • 1 Crossref
AbstractAbstract PDF
A 36-year-old female patient with aplastic anemia developed massive hemoptysis and was placed on ventilator support. However, airway obstruction by blood clots triggered desaturation and ventilator malfunction. Manual ventilation was initiated to improve oxygenation, and emergency flexible bronchoscopy was performed to clear the airway. Nevertheless, the patient developed extensive subcutaneous emphysema, pneumothorax, and pneumomediastinum.

Citations

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  • Experimental validation of a portable tidal volume indicator for bag valve mask ventilation
    Benjamin S. Maxey, Luke A. White, Giovanni F. Solitro, Steven A. Conrad, J. Steven Alexander
    BMC Biomedical Engineering.2022;[Epub]     CrossRef
Gastroenterology
Nasogastric Tube Syndrome: Why Is It Important in the Intensive Care Unit?
Taehyun Kim, Seong Min Kim, Sung Birm Sohn, Yeon Ho Lee, Sang Youn Lim, Jae Kyeom Sim
Korean J Crit Care Med. 2015;30(3):231-233.   Published online August 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.3.231
  • 14,459 View
  • 165 Download
  • 1 Crossref
AbstractAbstract PDF
Although the nasogastric tube (NGT) is widely used in critically ill patients, most intensivists do not give much thought to it or its possible complications. NGT syndrome is a rare but fatal complication characterized by throat pain and vocal cord paralysis in the presence of NGT. Recently, we experienced a case of NGT syndrome developed in an 86-year-old female twelve days after NGT insertion. We immediately removed the NGT and secured the airway by tracheostomy. She was treated successfully with an intravenous antibiotic, steroid and proton pump inhibitor and the syndrome did not recur after reinsertion of the NGT.

Citations

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  • Nasogastric tube syndrome: A Meta-summary of case reports
    Deven Juneja, Prashant Nasa, Gunjan Chanchalani, Ravi Jain
    World Journal of Clinical Cases.2024; 12(1): 119.     CrossRef
Neurology
Multiple System Atrophy Manifested by Bilateral Vocal Cord Palsy as an Initial Sign
Yuri Seo, Soomin Jeung, Heeyoung Yoon, Min-Chul Kim, Nah Kyum Lee, Byeong Zu Ghang, Sun Ju Chung, Younsuck Koh
Korean J Crit Care Med. 2015;30(2):123-127.   Published online May 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.2.123
  • 4,525 View
  • 67 Download
AbstractAbstract PDF
A 71-year-old male initially presented with vocal cord palsy and underwent tracheostomy. After thorough examination, urogenital dysfunction, orthostatic hypotension, and Parkinsonism were found, which led to the diagnosis of multiple system atrophy (MSA). After the tracheostomy, bi-level positive airway pressure ventilation was required during the night due to nocturnal hypoxemia. Nighttime hypoxemia is related to central sleep apnea, which is one of the manifestations of MSA. This is the first case of MSA manifested by bilateral vocal cord palsy as an initial sign in Korea. This case supports the notion that MSA should be taken into consideration when vocal cord paralysis is observed.
Pulmonary
Obstructive Fibrinous Tracheal Pseudomembrane Presented with Atelectasis
Jick Hwan Ha, Hyewon Lee, Young Jae Park, Hyeon Hui Kang, Hwa Sik Moon, Sang Haak Lee
Korean J Crit Care Med. 2014;29(2):110-113.   Published online May 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.2.110
  • 4,540 View
  • 57 Download
  • 2 Crossref
AbstractAbstract PDF
Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare condition usually associated with endotracheal intubation. Airway obstruction caused by OFTP may occur after endotracheal tube extubation and can lead to severe respiratory distress. It is a rare but potentially fatal complication. In this report, we present a case of OFTP presented with atelectasis that caused dyspnea after extubation and was successfully treated by mechanical removal using a rigid bronchoscope.

Citations

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  • Obstructive Fibrinous Tracheal Pseudomembrane
    Yoann Ammar, Juliette Vella-Boucaud, Claire Launois, Hervé Vallerand, Sandra Dury, François Lebargy, Gaëtan Deslee, Jeanne-Marie Perotin
    Anesthesia & Analgesia.2017; 125(1): 172.     CrossRef
  • Obstructive Fibrinous Tracheal Pseudomembrane: An Update
    Alberto Manassero, Matteo Bossolasco
    Korean Journal of Critical Care Medicine.2014; 29(3): 241.     CrossRef
Pulmonary
Total Unilateral Obstruction by Sputum Immediately after Tracheal Bougienage
Kyunam Kim, Jonghun Jun, Miae Jeong, Songlark Choi, Youngsun Lee
Korean J Crit Care Med. 2014;29(1):32-37.   Published online February 28, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.1.32
  • 5,533 View
  • 64 Download
AbstractAbstract PDF
A 25-year-old man developed tracheal stenosis due to prolonged intubation for five days. Immediately after bougienage, his left lung was not possible to ventilate and emergency tracheostomy was performed to produce ample space for airflow. Fiberoptic bronchoscopy showed that his left main bronchus was totally obstructed by sputum at the entrance of the superior and inferior lobar bronchi. Inadequate airway clearance increases the risk of infection and airway obstruction. We suggest chest physiotherapy be applied to all patients in the intensive care unit (ICU), especially patients with tracheal stenosis, due to its positive impact on pulmonary functional ability and ICU stay.
Airway Obstruction and Respiratory Failure Due to Aspergillus Tracheobronchitis
Yousang Ko, So Yeon Lim, Gee Young Suh, Kyeongman Jeon, Seo Goo Han
Korean J Crit Care Med. 2013;28(1):67-71.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.67
  • 2,656 View
  • 37 Download
  • 1 Crossref
AbstractAbstract PDF
Invasive aspergillosis is a serious threat and a leading cause of death in immunocompromised patients. Aspergillus tracheobronchitis is an infrequent but severe form of invasive pulmonary aspergillos in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. We report an extraordinary case of acute airway obstruction and respiratory failure due to Aspergillus tracheobronchitis in an immunocompromised patient. Fiberoptic bronchoscopy revealed extensive obstruction of both the main and lobar bronchus with yellowish nodules strongly adhered to the bronchial wall; both histologic examination and culture of these nodules revealed Aspergillus fumigatus. Even with early detection of an intraluminal growth of Aspergillus and prompt institution of antifungal therapy, the patient died of refractory hypoxemia a few days later. This report shows that Aspergillus tracheobronchitis should be considered in immunocompromised patients with suspected lung infection even when the main radiographic finding is atelectasis.

Citations

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  • Death due to Aspergillus Tracheobronchitis: An Autopsy Case
    Tack Kune You, Byung Ha Choi, Bong Woo Lee, Young Shik Choi
    Korean Journal of Legal Medicine.2018; 42(4): 164.     CrossRef
Extracorporeal Membrane Oxygenation as a Bridge to Definitive Airway Security in 3 Severe Acute Extrinsic Airway Compression Patients: A Case Report
Jiwon Lyu, Jin Won Huh, Chae Man Lim, Youn Suck Koh, Sang Bum Hong
Korean J Crit Care Med. 2011;26(1):29-33.
DOI: https://doi.org/10.4266/kjccm.2011.26.1.29
  • 2,221 View
  • 22 Download
AbstractAbstract PDF
Extracorporeal membrane oxygenation (ECMO) has been used for cardiac and respiratory failure for over 30 years. Recently, however, ECMO has emerged as a useful means of short-term support in the management of hypoxic patients for nontraditional indications. Here, we report the use of veno-venous ECMO as a bridge to support a patient with severe airway obstruction because of tumor compression. Case 1: A patient with extrinsic airway compression secondary to a large metastatic cancer on neck was successfully managed using ECMO. Case 2: The successful use of ECMO to support a patient with extrinsic airway compression secondary to a recurred thyroid cancer. Case 3: A pregnant woman with airway obstruction secondary to metastatic lymphadenopathy of lung cancer who underwent successful tracheal stent insertion. The 3 patients were successfully weaned off ECMO without any complication. Although these conditions are uncommon indications, ECMO is a potential option for such life-threatening conditions.
Negative Pressure Pulmonary Edema and Hemorrhage after Extubation: A Case Report
Yoon Suk Ra, Chi Hyo Kim, Jong In Han, Dong Yeon Kim
Korean J Crit Care Med. 2010;25(2):98-103.
DOI: https://doi.org/10.4266/kjccm.2010.25.2.98
  • 2,583 View
  • 24 Download
  • 1 Crossref
AbstractAbstract PDF
Negative pressure pulmonary edema (NPPE) is a rare complication of acute airway obstruction which develops after endotracheal extubation. The proposed mechanism is generation of very low negative pressure during laryngospasm by inspiratory efforts, which leads to alveolar exudation and hemorrhage. The diagnosis of NPPE is confirmed by clinical findings of tachypnea, pink prothy sputum in the endotracheal tube, hypoxemia on arterial blood gas analysis, and distinctive radiologic findings. NPPE is usually self-limited within 48 hours when diagnosed early and treated appropriately. We report three patients who recovered from NPPE without complications.

Citations

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  • Negative pressure pulmonary edema after endotracheal tube extubation during recovery of general anesthesia in a pediatric patient with cerebral palsy
    Hyun Jung Kim, Sun Kyung Park
    Allergy, Asthma & Respiratory Disease.2022; 10(4): 229.     CrossRef
Airway Obstruction Caused by Prevertebral Soft Tissue Swelling after Anterior Cervical Discectomy and Fusion: A Case Report
Ja Hyun Ku, Eun Su Park, Young Su Lim
Korean J Crit Care Med. 2010;25(2):107-111.
DOI: https://doi.org/10.4266/kjccm.2010.25.2.107
  • 2,164 View
  • 15 Download
AbstractAbstract PDF
Acute airway obstruction after anterior cervical surgery is rare, but does occur. Airway obstruction due to prevertebral soft tissue swelling is unpredictable, but potentially lethal. We managed a 67-year-old male who developed acute airway obstruction caused by marked prevertebral soft tissue swelling on the first day after anterior cervical discectomy and fusion at the C4-C5 level.
A Case of Pulmonary Edema which Developed after Difficult Endotracheal Intubation of Hunter Syndrome: A Case Report
Ha Jin Kim, Seok Hwa Yoon, Yoon Hee Kim, Hee Suk Yoon
Korean J Crit Care Med. 2005;20(2):187-191.
  • 1,569 View
  • 33 Download
AbstractAbstract PDF
Hunter syndrome is one of the mucopolysaccharidoses, characterized by abnormal accumulation and deposition of mucopolysaccharides in the tissues of several organs which are known to complicate anaesthetic and airway management. We experienced a case of pulmonary edema which developed during induction of general anesthesia of Hunter syndrome after several attempts of intubation and airway obstruction.
Pulmonary Edema due to Upper Airway Obstruction after Neck Mass Excision of the Patient with Cerebral Palsy
Moon Seok Chang, Hun Cho, Hae Ja Lim, Seong Ho Chang, Nan Suk Kim
Korean J Crit Care Med. 1997;12(2):183-186.
  • 1,388 View
  • 7 Download
AbstractAbstract PDF
Because the emergence from anesthesia may be delayed in the patient with the cerebral palsy, extubation must be delayed until consciousness is recovered completely. Postoperative pulmonary edema has several causes and one of them, upper airway obstruction is rare. We had experienced pulmonary edema due to upper airway obstruction after neck mass excision in the patient with cerebral palsy, who was 21-year-old, 50 kg, male and normal preoperative laboratory data. There was no significant change in blood volume during operation for 1 hour. After operation, the patient breathed spontaneously and the endotracheal tube was extubated in the operating room. When the patient was transfered to the recovery room, he had cyanosis, intercostal and substernal retraction, and the pulse oximeter showed very low oxygen saturation. We supplied oxygen to the patient and reintubated him, and recognized the pinkish frothy sputum by suction of the endotracheal tube. On the portable chest X-ray film of the patient at the moment, hazy increased density on both lung fields indicating pulmonary edema, but the heart size was not increased. By routine treatment for pulmonary edema, the symtoms and signs of the patient were improved. He had stayed for 1 day in the SICU and then transfered to the general ward.

ACC : Acute and Critical Care