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Infection and Drug Resistance 2023Plastic bronchitis (PB) is a rare and severe lung disease. It can be triggered by influenza virus infection, which is a common respiratory infection in children....
BACKGROUND
Plastic bronchitis (PB) is a rare and severe lung disease. It can be triggered by influenza virus infection, which is a common respiratory infection in children. Bronchoscopy can aid in the early detection and treatment of PB. However, the outcomes and risk for PB development in pediatric patients with influenza virus infection are not fully understood.
METHODS
Data from 321 children diagnosed with influenza virus pneumonia who underwent bronchoscopy examinations between 1st January, 2009 and 31st December, 2020 were retrospectively analyzed to assess the outcomes and risk factors associated with PB development.
RESULTS
This study included 97 girls and 224 boys with influenza virus pneumonia with a median age of 42 months. Among them, 36 patients (11.2%) were categorized as having PB based on bronchoscopy findings. PB patients had significantly longer fever durations (=0.010) and higher risks of developing severe conditions including respiratory failure (<0.001), acute respiratory distress syndrome (<0.001), and air-leak syndrome (<0.001) compared to non-PB patients. Conventional treatment including the use of neuraminidase inhibitors and antibiotics did not differ between the PB and non-PB patients, but PB patients required more anti-inflammatory treatment (=0.019) and ventilator support (<0.001). Combined univariate and multivariate analyses suggested that radiographic findings, including mediastinal emphysema (=0.012) and lung consolidation (=0.012), as well as increased levels of neutrophils (=0.026), aspartate aminotransferase (=0.004), and lactate dehydrogenase (<0.001), were identified as risk factors for PB development in patients with influenza virus pneumonia. Although PB patients required more intensive care and had longer hospital stays, they all recovered well after treatment.
CONCLUSION
Influenza virus infection is linked to PB development in children. Identifying risk factors and early intervention such as bronchoscopy can improve the prognosis of children with PB.
PubMed: 37366500
DOI: 10.2147/IDR.S405444 -
Journal of Intensive Care Medicine Nov 2023The occurrence of pneumomediastinum (PM) and/or pneumothorax (PTX) in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)... (Observational Study)
Observational Study
INTRODUCTION
The occurrence of pneumomediastinum (PM) and/or pneumothorax (PTX) in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was evaluated.
METHODS
This was a prospective observational study conducted in patients admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital in Madrid (Spain) between December 14, 2020 and September 28, 2021. All patients had a diagnosis of severe SARS-CoV-2 pneumonia and required noninvasive respiratory support (NIRS): high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP). The incidences of PM and/or PTX, overall and by NIRS, and their impact on the probabilities of invasive mechanical ventilation (IMV) and death were studied.
RESULTS
A total of 1306 patients were included. 4.3% (56/1306) developed PM/PTX, 3.8% (50/1306) PM, 1.6% (21/1306) PTX, and 1.1% (15/1306) PM + PTX. 16.1% (9/56) of patients with PM/PTX had HFNC alone, while 83.9% (47/56) had HFNC + CPAP/BiPAP. In comparison, 41.7% (521/1250) of patients without PM and PTX had HFNC alone (odds ratio [OR] 0.27; 95% confidence interval [95% CI] 0.13-0.55; < .001), while 58.3% (729/1250) had HFNC + CPAP/BiPAP (OR 3.73; 95% CI 1.81-7.68; < .001). The probability of needing IMV among patients with PM/PTX was 67.9% (36/53) (OR 7.46; 95% CI 4.12-13.50; < .001), while it was 22.1% (262/1185) among patients without PM and PTX. Mortality among patients with PM/PTX was 33.9% (19/56) (OR 4.39; 95% CI 2.45-7.85; < .001), while it was 10.5% (131/1250) among patients without PM and PTX.
CONCLUSIONS
In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia requiring NIRS, incidences of PM/PTX, PM, PTX, and PM + PTX were observed to be 4.3%, 3.8%, 1.6%, and 1.1%, respectively. Most patients with PM/PTX had HFNC + CPAP/BiPAP as the NIRS device, much more frequently than patients without PM and PTX. The probabilities of IMV and death among patients with PM/PTX were 64.3% and 33.9%, respectively, higher than those observed in patients without PM and PTX, which were 21.0% and 10.5%, respectively.
Topics: Humans; SARS-CoV-2; COVID-19; Respiratory Care Units; Mediastinal Emphysema; Pneumothorax; Pneumonia; Oxygen Inhalation Therapy; Respiratory Insufficiency; Noninvasive Ventilation
PubMed: 37306158
DOI: 10.1177/08850666231180165 -
Pediatrics and Neonatology Nov 2023Although uncommon, available evidence suggests that pneumorrhachis (PR) with spontaneous pneumomediastinum (SPM) in adulthood is usually benign and self-limiting. This...
BACKGROUND
Although uncommon, available evidence suggests that pneumorrhachis (PR) with spontaneous pneumomediastinum (SPM) in adulthood is usually benign and self-limiting. This study aimed to review our experience and identify the risk factors of PR in pediatric patients with SPM.
METHODS
Between September 2007 and September 2017, SPM in patients aged ≤18 years was retrospectively reviewed and clinical features and outcomes between SPM patients with and without PR were analyzed.
RESULTS
In total, thirty consecutive occurrences of SPM in 29 patients were finally identified and classified into SPM (n = 24) and SPM plus PR (n = 6) groups. No significant differences in received interventional exams, prophylactic antibiotic administration or restriction of oral intake between the two groups were found. Both groups were treated with hospitalization predominantly; but the SPM plus PR group tended to have longer length of hospital stay (median 5.5 vs. 3 days, p = 0.08). PR was observed more frequently in patients with abnormal serum C-reactive protein (CRP) levels (>5 mg/L), identified predisposing factors, and those with more severe grade of SPM (p = 0.005, 0.001 and < 0.001, respectively). On multivariable regression analysis, the SPM plus PR group exhibited more predisposing factors than did the SPM group (coefficient: 0.514, standard error: 0.136, p < 0.001). All patients were successfully treated without morbidity and mortality.
CONCLUSION
Although patients with pneumorrhachis retained a higher CRP level, more identified predisposing factors and prolonged inpatient care, conservative management without an extensive work-up would be an appropriate and favorable strategy in pediatrics with concurrent SPM and PR.
Topics: Humans; Child; Mediastinal Emphysema; Retrospective Studies; Pneumorrhachis; Taiwan; Tomography, X-Ray Computed
PubMed: 37301660
DOI: 10.1016/j.pedneo.2023.03.008 -
The American Journal of Case Reports Jun 2023BACKGROUND The nasogastric tube (NGT) is a common medical device, and serious complications associated with NGT insertions are rare. The most common serious complication...
BACKGROUND The nasogastric tube (NGT) is a common medical device, and serious complications associated with NGT insertions are rare. The most common serious complication is tracheal insertion; cervical emphysema and pneumomediastinum are rare. There are several methods for confirming the location of the NGT, but a single method of confirmation is often inadequate. Confirmation by air insufflation into the NGT is currently not recommended and is highly invasive. Here, we report a case of cervical emphysema and pneumomediastinum caused by an NGT. CASE REPORT A 94-year-old woman experienced a stroke and was hospitalized for neurosurgery. The nurse inserted an NGT and performed insufflation, but air sounds were not detected. Chest radiography did not reveal the tip of the NGT. Computed tomography (CT) revealed cervical emphysema, pneumomediastinum, an NGT bent in the esophagus, and the distal end of the NGT in the nasopharynx. Nasopharyngeal endoscopy revealed damaged nasopharyngeal mucosa and the distal end of the NGT. The patient was diagnosed with insufflated air passing through the damaged nasopharynx, which had spread to the cervical area and mediastinum. The NGT was removed, and the patient was treated with antibiotics. CT showed cervical emphysema, and the pneumomediastinum resolved after 20 days. CONCLUSIONS It is important to recognize that there are numerous serious and unexpected complications associated with NGT. Different methods should be considered and used to confirm the location of an NGT. Further studies on the confirmation methods and dissemination of such knowledge are required to reduce NGT complications.
Topics: Female; Humans; Aged, 80 and over; Mediastinal Emphysema; Emphysema; Intubation, Gastrointestinal; Radiography; Tomography, X-Ray Computed; Pulmonary Emphysema
PubMed: 37269087
DOI: 10.12659/AJCR.939836 -
Journal of Investigative Medicine High... 2023With the previous worldwide initial coronavirus disease 2019 (COVID-19) pandemic, a notable rise in spontaneous pneumomediastinum with/without pneumothorax (SPP) has...
With the previous worldwide initial coronavirus disease 2019 (COVID-19) pandemic, a notable rise in spontaneous pneumomediastinum with/without pneumothorax (SPP) has been noted. Most cases were initially reported as complications secondary to barotrauma from mechanical ventilation (MV) with COVID-19. However, with the Delta strain, starting from December 2020, there have been multiple reports of SPP. The SPP is an uncommon complication outside use of assisted ventilation with either noninvasive positive pressure ventilation (NIPPV) or MV. COVID-19 has been linked to higher incidence of SPP without use of NIPPV or MV. We present a series of 5 cases with a polymerase chain reaction-confirmed COVID-19 diagnostic testing whose hospital course was complicated by SPP unrelated to the use of either NIPPV or MV.
Topics: Humans; Pneumothorax; COVID-19 Testing; Mediastinal Emphysema; COVID-19; Respiration, Artificial
PubMed: 37219068
DOI: 10.1177/23247096231176216 -
Nigerian Journal of Clinical Practice Apr 2023Spontaneous pneumomediastinum (SPM) is defined as free air or gas in the mediastinum that is not associated with an obvious cause such as chest trauma. The SPM results... (Review)
Review
Spontaneous pneumomediastinum (SPM) is defined as free air or gas in the mediastinum that is not associated with an obvious cause such as chest trauma. The SPM results from acutely elevated intra-alveolar pressure: The high-pressure gradient between the distal alveoli and the pulmonary interstitium leads to alveolar rupture. This causes free gas to separate through the peribronchovascular fascial sheaths (interstitial emphysema) into the hilum and then into the mediastinum. Once the gas is in the mediastinum, it can travel up to the cervical soft tissues (even the retroperitoneum) producing subcutaneous emphysema. The Macklin effect appears on thoracic computed tomography (CT) as linear air collections adjacent to bronchovascular sheaths. This case report presents CT findings of SPM due to the Macklin effect in three cases and a brief literature review on this subject.
Topics: Humans; Mediastinal Emphysema; Neck; Pulmonary Alveoli; Subcutaneous Emphysema; Thoracic Injuries; Tomography, X-Ray Computed
PubMed: 37203121
DOI: 10.4103/njcp.njcp_901_22 -
The Pan African Medical Journal 2023
Topics: Humans; COVID-19; Pneumothorax; Subcutaneous Emphysema; Mediastinal Emphysema; Emphysema
PubMed: 37193105
DOI: 10.11604/pamj.2023.44.84.36292 -
Frontiers in Medicine 2023The manifestation of severe pneumonia is only occasional, and pneumomediastinum is a condition that occurs rarely in Coronavirus disease 2019 (COVID-19) patients,...
The manifestation of severe pneumonia is only occasional, and pneumomediastinum is a condition that occurs rarely in Coronavirus disease 2019 (COVID-19) patients, especially in those patients who are infected with the Omicron variant. In addition, whether severe pneumonia or pneumomediastinum often occurs in patients in older age, in poor physical condition, or with underlying diseases remains to be ascertained. To date, severe pneumonia and pneumomediastinum due to Omicron infection had not been reported in a young patient with an excellent physical condition. In this study, we report such a case with the aforementioned manifestations in a robust adolescent infected with Omicron BA.5.2.
PubMed: 37138757
DOI: 10.3389/fmed.2023.1132630 -
The American Journal of Case Reports May 2023BACKGROUND Pneumomediastinum, or mediastinal emphysema, means air present inside the mediastinum. It usually presents with symptoms of chest pain and shortness of...
BACKGROUND Pneumomediastinum, or mediastinal emphysema, means air present inside the mediastinum. It usually presents with symptoms of chest pain and shortness of breath. Examination can be significant for crepitus along the neck area. There are many risk factors associated with pneumomediastinum, including asthma and COVID-19. Most cases of pneumomediastinum improve with conservative management, and surgery (mediastinotomy) is reserved for complicated cases with tension pneumomediastinum. CASE REPORT This is the case of a 23-year-old man who presented with chest tightness after 3.5 h of cycling. The patient did have a prior history of clinically stable asthma, with no recent exacerbation, and denied any other associative factors. Imaging was significant for pneumomediastinum. The patient was admitted for observation in the hospital and treated with supportive care, without any surgical intervention. The patient had appropriate improvement in his symptoms in 24 h. Repeat imaging showed improvement in the pneumomediastinum, and the patient was discharged to outpatient follow-up. CONCLUSIONS Our case presents a unique link between cycling and pneumomediastinum. Prolonged cycling may emerge as a risk factor for this complication. People with a previous history of pneumomediastinum should be careful to review other risk factors prior to planning long-distance bicycling. Physicians need to keep this differential diagnosis in mind when encountering a patient with similar symptoms so that a timely diagnosis is made.
Topics: Male; Humans; Young Adult; Adult; Mediastinal Emphysema; Bicycling; COVID-19; Tomography, X-Ray Computed; Asthma; Chest Pain
PubMed: 37122129
DOI: 10.12659/AJCR.939170