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Matsuura H, Matsui Y, Okuda K, Kishimoto M. Isolated Lung Ventilation With Tracheostomy Using Two Intubation Tubes for Severe Endotracheal Hemorrhage Due to Pulmonary Contusion. Cureus 2024; 16:e64443. [PMID: 39135810 PMCID: PMC11317845 DOI: 10.7759/cureus.64443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 08/15/2024] Open
Abstract
A 72-year-old man presented with severe pulmonary contusions and multiple traumas, including aortic injury, pelvic fracture, and renal injury. The patient required multidisciplinary treatment, including transcatheter arterial embolization, thoracic endovascular aortic repair, right lung upper lobe partial resection, and massive transfusion. During the initial treatment, the patient experienced respiratory failure due to endotracheal bleeding, and we attempted isolated lung ventilation with a 37 Fr double-lumen endotracheal intubation tube. Although drainage by suction and protection of the healthy lung was vital, the patient was unable to maintain ventilation volume because of poor drainage. Additionally, the respiratory status deteriorated. To resolve the situation, a tracheotomy was performed and two endotracheal intubation tubes (6.0 mm inner diameter, and 9.0 mm outer diameter) were inserted through a large U-shaped tracheal hole 18 hours after admission. The respiratory status of the patient gradually improved after the procedure. There were two advantages of this method of respiratory management. Firstly, each of the two endotracheal tubes had a separate cuff, allowing more reliable separation of the healthy lung from the injured lung. Secondly, bronchoscopes of sufficient diameter (4.9 mm outer diameter ) were used bilaterally, allowing sufficient drainage of viscous airway secretions mixed with hematoma and improving atelectasis. Although venovenous extracorporeal membrane oxygenation is a crucial support tool when the respiratory status deteriorates due to severe pulmonary contusions, our method of airway management may be attempted in patients with multiple traumatic injuries with coagulopathy.
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Affiliation(s)
- Hiroshi Matsuura
- Emergency and Critical Care, Osaka Prefectural Nakakawachi Emergency and Critical Care Center, Osaka, JPN
| | - Yuki Matsui
- Emergency and Critical Care, Osaka Prefectural Nakakawachi Emergency and Critical Care Center, Osaka, JPN
| | - Kazunori Okuda
- Emergency and Critical Care, Osaka Prefectural Nakakawachi Emergency and Critical Care Center, Osaka, JPN
| | - Masafumi Kishimoto
- Emergency and Critical Care, Osaka Prefectural Nakakawachi Emergency and Critical Care Center, Osaka, JPN
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2
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Yoneda R, Matsuyoshi T, Yogi T, Sato Y, Hamaguchi J, Shimizu K. Combined use of veno-venous extracorporeal membrane oxygenation and asynchronous independent lung ventilation after thoracic surgery for lung abscess. Clin Case Rep 2024; 12:e8354. [PMID: 38161632 PMCID: PMC10753623 DOI: 10.1002/ccr3.8354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/21/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024] Open
Abstract
We used independent lung ventilation (ILV) during veno-venous extracorporeal membrane oxygenation (V-V ECMO) after lung abscess surgery in a patient with severe hypoxia and air leak. ILV can be effective in V-V ECMO as unilateral lung air leak.
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Affiliation(s)
- Ryuhei Yoneda
- Department of Emergency MedicineTokyo Metropolitan Tama Medical CenterTokyoJapan
| | - Takeo Matsuyoshi
- Department of Emergency MedicineTokyo Metropolitan Tama Medical CenterTokyoJapan
| | - Tatsuro Yogi
- Department of Emergency MedicineUrasoe General HospitalUrasoeJapan
| | - Yuichi Sato
- Department of Emergency MedicineTokyo Metropolitan Tama Medical CenterTokyoJapan
| | - Jun Hamaguchi
- Department of Emergency MedicineTokyo Metropolitan Tama Medical CenterTokyoJapan
| | - Keiki Shimizu
- Department of Emergency MedicineTokyo Metropolitan Tama Medical CenterTokyoJapan
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3
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Barjaktarevic I, Meyerowitz G, Williams O, Emeruwa IO, Hoftman N. Proof-of-concept study of compartmentalized lung ventilation using system for asymmetric flow regulation (SAFR). FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1121674. [PMID: 37065968 PMCID: PMC10101564 DOI: 10.3389/fmedt.2023.1121674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/10/2023] [Indexed: 04/03/2023] Open
Abstract
Asymmetrical distribution of acute lung injury in mechanically ventilated patients can result in a heterogeneity of gas distribution between different regions, potentially worsening ventilation-perfusion matching. Furthermore, overdistension of healthier, more compliant lung regions can lead to barotrauma and limit the effect of increased PEEP on lung recruitment. We propose a System for Asymmetric Flow Regulation (SAFR) which, combined with a novel double lumen endobronchial tube (DLT) may offer individualized lung ventilation to the left and right lungs, better matching each lung's mechanics and pathophysiology. In this preclinical experimental model, the performance of SAFR on gas distribution in a two-lung simulation system was tested. Our results indicate that SAFR may be a technically feasible and potentially clinically useful although further research is warranted.
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Affiliation(s)
- Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, University of California Los Angeles, CA, United States
- Correspondence: Igor Barjaktarevic
| | - Glen Meyerowitz
- UCLA Biodesign, University of California Los Angeles, Los Angeles, California, CA, United States
| | - Onike Williams
- UCLA Biodesign, University of California Los Angeles, Los Angeles, California, CA, United States
| | - I. Obi Emeruwa
- Division of Pulmonary and Critical Care Medicine, University of California Los Angeles, CA, United States
- UCLA Biodesign, University of California Los Angeles, Los Angeles, California, CA, United States
| | - Nir Hoftman
- Department of Anesthesiology, University of California Los Angeles, CA, United States
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Segmental Lung Recruitment in Patients with Bilateral COVID-19 Pneumonia Complicated by Acute Respiratory Distress Syndrome: A Case Report. Medicina (B Aires) 2023; 59:medicina59010142. [PMID: 36676766 PMCID: PMC9861328 DOI: 10.3390/medicina59010142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
Bilateral COVID-19 pneumonia is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and usually leads to life-threatening acute respiratory distress syndrome (ARDS). Treatment of patients with ARDS is difficult and usually involves protective mechanical ventilation and various types of recruitment maneuvers. A segmental lung recruitment maneuver by independent lung ventilation has been described as a successful recruitment maneuver in patients with lobar pneumonia, and may, therefore, be useful for the treatment of patients with bilateral COVID-19 pneumonia complicated by ARDS in the critical phase of the disease when all other therapeutic options have been exhausted. The aim of this case series was to present a case report of four mechanically ventilated patients with severe bilateral COVID-19 pneumonia complicated by ARDS using the segmental lung recruitment maneuver. The effect of the segmental lung recruitment maneuver was assessed by the increase in PaO2/FiO2 ratio and the lung ultrasound (LUS) scoring system (0 points-presence of sliding lungs with A-lines or one or two isolated B-lines; 1 point-moderate loss of lung ventilation with three to five B lines; 2 points-severe loss of lung ventilation with more than five B lines (B pattern); and 3 points-lung consolidation) determined 12, 24, and 48 h after segmental lung recruitment. In three of four patients with bilateral COVID-19 pneumonia complicated by ARDS, an increase in the PaO2/FiO2 ratio and an improvement in the LUS scoring system were observed 48 h after segmental lung recruitment. In conclusion, the segmental lung recruitment maneuver in patients with bilateral COVID-19 complicated by ARDS is an effective method of lung recruitment and may be a useful treatment method.
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5
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Bastia L, Rozé H, Brochard L. Asymmetrical Lung Injury: Management and Outcome. Semin Respir Crit Care Med 2022; 43:369-378. [PMID: 35785812 DOI: 10.1055/s-0042-1744303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Among mechanically ventilated patients, asymmetrical lung injury is probably extremely frequent in the intensive care unit but the lack of standardized measurements does not allow to describe any prevalence among mechanically ventilated patients. Many past studies have focused only on unilateral injury and have mostly described the effect of lateral positioning. The good lung put downward might receive more perfusion while the sick lung placed upward receive more ventilation than supine. This usually results in better oxygenation but can also promote atelectasis in the healthy lung and no consensus has emerged on the clinical indication of this posture. Recently, electrical impedance tomography (EIT) has allowed for the first time to precisely describe the distribution of ventilation in each lung and to better study asymmetrical lung injury. At low positive-end-expiratory pressure (PEEP), a very heterogeneous ventilation exists between the two lungs and the initial increase in PEEP first helps to recruit the sick lung and protect the healthier lung. However, further increasing PEEP distends the less injured lung and must be avoided. The right level can be found using EIT and transpulmonary pressure. In addition, EIT can show that in the two lungs, airway closure is present but with very different airway opening pressures (AOPs) which cannot be identified on a global assessment. This may suggest a very different PEEP level than on a global assessment. Lastly, epidemiological studies suggest that in hypoxemic patients, the number of quadrants involved has a strong prognostic value. The number of quadrants is more important than the location of the unilateral or bilateral nature of the involvement for the prognosis, and hypoxemic patients with unilateral lung injury should probably be considered as requiring lung protective ventilation as classical acute respiratory distress syndrome.
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Affiliation(s)
- Luca Bastia
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Hadrien Rozé
- Thoracic Surgery and Lung Transplant Unit, Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Haut Leveque Hospital, Pessac, France.,Centre de Recherche Cardio Thoracique INSERM 1045, Pessac, France
| | - Laurent Brochard
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Canada
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Ueno Y, Harada S, Sato K, Momota K, Sato H, Akimoto Y, Arai Y, Nunomura T, Ishihara M, Tane N, Itagaki T, Nishioka Y, Oto J. Independent lung ventilation for the management of acute allograft rejection after single-lung transplantation for end-stage emphysema. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:323-327. [DOI: 10.2152/jmi.69.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Yoshitoyo Ueno
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Saki Harada
- Department of Respiratory Medicine and Rheumatology, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Koji Sato
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Kazuki Momota
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Hiroki Sato
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Yusuke Akimoto
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Yuta Arai
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Toshiyuki Nunomura
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Manabu Ishihara
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Natsuki Tane
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Taiga Itagaki
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Jun Oto
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
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Kramek-Romanowska K, Stecka AM, Zieliński K, Dorosz A, Okrzeja P, Michnikowski M, Odziomek M. Independent Lung Ventilation-Experimental Studies on a 3D Printed Respiratory Tract Model. MATERIALS 2021; 14:ma14185189. [PMID: 34576415 PMCID: PMC8472474 DOI: 10.3390/ma14185189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 12/04/2022]
Abstract
Independent lung ventilation (ILV) is a life-saving procedure in unilateral pulmonary pathologies. ILV is underused in clinical practice, mostly due to the technically demanding placement of a double lumen endotracheal tube (ETT). Moreover, the determination of ventilation parameters for each lung in vivo is limited. In recent years, the development of 3D printing techniques enabled the production of highly accurate physical models of anatomical structures used for in vitro research, considering the high risk of in vivo studies. The purpose of this study was to assess the influence of double-lumen ETT on the gas transport and mixing in the anatomically accurate 3D-printed model of the bronchial tree, with lung lobes of different compliances, using various ventilation modes. The bronchial tree was obtained from Respiratory Drug Delivery (RDD Online, Richmond, VA, USA), processed and printed by a dual extruder FFF 3D printer. The test system was also composed of left side double-lumen endotracheal tube, Siemens Test Lung 190 and anesthetic breathing bag (as lobes). Pressure and flow measurements were taken at the outlets of the secondary bronchus. The measured resistance increased six times in the presence of double-lumen ETT. Differences between the flow distribution to the less and more compliant lobe were more significant for the airways with double-lumen ETT. The ability to predict the actual flow distribution in model airways is necessary to conduct effective ILV in clinical conditions.
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Affiliation(s)
- Katarzyna Kramek-Romanowska
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks Trojdena 4, 02-109 Warsaw, Poland; (A.M.S.); (K.Z.); (P.O.); (M.M.)
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Waryńskiego 1, 00-645 Warsaw, Poland; (A.D.); (M.O.)
- Correspondence:
| | - Anna M. Stecka
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks Trojdena 4, 02-109 Warsaw, Poland; (A.M.S.); (K.Z.); (P.O.); (M.M.)
| | - Krzysztof Zieliński
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks Trojdena 4, 02-109 Warsaw, Poland; (A.M.S.); (K.Z.); (P.O.); (M.M.)
| | - Agata Dorosz
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Waryńskiego 1, 00-645 Warsaw, Poland; (A.D.); (M.O.)
| | - Piotr Okrzeja
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks Trojdena 4, 02-109 Warsaw, Poland; (A.M.S.); (K.Z.); (P.O.); (M.M.)
| | - Marcin Michnikowski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks Trojdena 4, 02-109 Warsaw, Poland; (A.M.S.); (K.Z.); (P.O.); (M.M.)
| | - Marcin Odziomek
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Waryńskiego 1, 00-645 Warsaw, Poland; (A.D.); (M.O.)
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Udurgucu M, Albayrak H, Kinik Kaya HE, Hancıoğlu S, Yener N. Independent Lung Ventilation in a Pediatric Patient with a Firearm Injury. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2021; 34:112-114. [PMID: 34495746 DOI: 10.1089/ped.2021.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Chest trauma is uncommon in pediatric patients, however, it may be a cause of significant morbidity and mortality. The type and extent of the injury may lead to ventilation and perfusion problems, therefore, there may be a need for mechanical ventilation. Conclusions: "Independent lung ventilation" may be an appropriate option in selected cases in which the aim is to protect the healthy lung or ventilation cannot be obtained with known mechanical ventilation methods. Case: We presented a pediatric patient followed up in the intensive care unit because of a firearm injury, in whom left lung expansion could not be obtained despite repeated interventions, and independent lung ventilation resulted in success.
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Affiliation(s)
- Muhammed Udurgucu
- Divisions of Pediatric Critical Care and Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Hatice Albayrak
- Divisions of Pediatric Critical Care and Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Hatice Elif Kinik Kaya
- Divisions of Pediatric Critical Care and Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Sertaç Hancıoğlu
- Divisions of Pediatric Surgery, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Nazik Yener
- Divisions of Pediatric Critical Care and Ondokuz Mayıs University School of Medicine, Samsun, Turkey
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Shen C, Ma L. New acute respiratory management in tracheal rupture caused by chest trauma. J Cardiothorac Surg 2020; 15:253. [PMID: 32919470 PMCID: PMC7488733 DOI: 10.1186/s13019-020-01298-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/03/2020] [Indexed: 02/08/2023] Open
Abstract
We report a case who is a 33-year-old man admitted to our Emergency room for chest trauma caused by the factory's mechanical arm. Despite the endotracheal tube, the patient's respiratory state was poor and the oxygen saturation did not improve and the subcutaneous emphysema progressed. To improve distressed breathing, we first proposed the concept "mechanical ventilation with dual ventilator" to maintain oxygen saturation of the patient. This is, to our knowledge, the first report of using a special mechanical ventilation method in emergency surgery.
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Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lin Ma
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, 610041, China.
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Boisen ML, Schisler T, Kolarczyk L, Melnyk V, Rolleri N, Bottiger B, Klinger R, Teeter E, Rao VK, Gelzinis TA. The Year in Thoracic Anesthesia: Selected Highlights from 2019. J Cardiothorac Vasc Anesth 2020; 34:1733-1744. [PMID: 32430201 DOI: 10.1053/j.jvca.2020.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 12/25/2022]
Abstract
THIS special article is the 4th in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr. Kaplan; the associate editor-in-chief, Dr. Augoustides; and the editorial board for the opportunity to expand this series, the research highlights of the year that specifically pertain to the specialty of thoracic anesthesia. The major themes selected for 2019 are outlined in this introduction, and each highlight is reviewed in detail in the main body of the article. The literature highlights in this specialty for 2019 include updates in the preoperative assessment and optimization of patients undergoing lung resection and esophagectomy, updates in one lung ventilation (OLV) and protective ventilation during OLV, a review of recent meta-analyses comparing truncal blocks with paravertebral catheters and the introduction of a new truncal block, meta-analyses comparing nonintubated video-assisted thoracoscopic surgery (VATS) with those performed using endotracheal intubation, a review of the Society of Thoracic Surgeons (STS) recent composite score rating for pulmonary resection of lung cancer, and an update of the Enhanced Recovery After Surgery (ERAS) guidelines for both lung and esophageal surgery.
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Affiliation(s)
- Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Travis Schisler
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, Canada
| | - Lavinia Kolarczyk
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Vladyslav Melnyk
- Department of Anesthesiology and Pain Medicine, University of Toronto - Toronto General Hospital, Toronto, Canada
| | - Noah Rolleri
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Emily Teeter
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Vidya K Rao
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Theresa A Gelzinis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
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