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Medicine Aug 2023Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is used in tracheostomy but not in cases of airway obstruction. This case report explores the use...
Addressing desaturation in a tracheal stenosis patient using the transnasal humidified rapid-insufflation ventilatory exchange technique during tracheostomy: A case report.
RATIONALE
Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is used in tracheostomy but not in cases of airway obstruction. This case report explores the use of THRIVE for managing airway obstruction during tracheostomy in patients with subglottic and tracheal stenosis, thereby addressing the current knowledge gap and exploring its potential for airway management.
PATIENT CONCERNS
A 63-year-old female with subglottic and tracheal stenoses underwent tracheostomy. Multiple attempts to establish a patent airway were unsuccessful, and oxygen saturation dropped to 56%.
DIAGNOSIS
Endotracheal tube was directed toward the tracheal wall, causing airway obstruction.
INTERVENTIONS
THRIVE was administered to the patient. Subsequently, the tube position was adjusted to enhance ventilation.
OUTCOMES
The patient's oxygen saturation increased to 99%. The postoperative complications, including subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumopericardium, resolved. The patient was discharged on postoperative day 9.
LESSONS
THRIVE could be considered a temporary measure to enhance oxygenation before initiating a definitive treatment strategy.
Topics: Female; Humans; Middle Aged; Tracheostomy; Tracheal Stenosis; Insufflation; Administration, Intranasal; Apnea; Airway Obstruction
PubMed: 37543766
DOI: 10.1097/MD.0000000000034567 -
Revista Da Sociedade Brasileira de... 2023
Topics: Humans; COVID-19; Pneumothorax; Pneumopericardium; Mediastinal Emphysema; Fistula
PubMed: 37493746
DOI: 10.1590/0037-8682-0188-2023 -
Circulation Reports Jul 2023
PubMed: 37431513
DOI: 10.1253/circrep.CR-23-0023 -
Journal of Geriatric Cardiology : JGC Jun 2023
PubMed: 37416522
DOI: 10.26599/1671-5411.2023.06.008 -
Cureus May 2023Pneumopericardium is defined as the collection of air inside the pericardium. Gastro-pericardial fistula is one of its rarest etiologies. We are presenting a case of...
Pneumopericardium is defined as the collection of air inside the pericardium. Gastro-pericardial fistula is one of its rarest etiologies. We are presenting a case of pneumopericardium due to gastro-pericardial fistula secondary to gastric cancer presented with an inferior ST-elevation myocardial infarction (STEMI)-like picture. Our case is a 57-year-old male with a past medical history of metastatic gastric cancer status post chemotherapy and radiotherapy who presented to the emergency with acute onset severe burning chest pain with radiation to his back. He was diaphoretic, saturating 96% on room air, and hypotensive with a blood pressure of 80/50 mmHg, and his EKG showed sinus rhythm with a heart rate of 60 BPM and ST elevation in inferior leads meeting STEMI criteria. The patient was transferred for an emergency coronary angiogram with possible percutaneous intervention. Surprisingly, no significant lesions in his epicardial vessels would corroborate his clinical presentation and EKG changes. The decision was to obtain CT angiography to exclude aortic dissection and pulmonary embolism. His CT chest revealed a large pneumopericardium with a gastric-pericardial fistula. A nasogastric tube was placed with suctioning of gastric contents. Given his tamponade physiology, it was decided to do emergent pericardiocentesis draining only 20 cc of gastric contents and a significant amount of air. After the procedure, the patient was transferred to the ICU with stable hemodynamics. The case was discussed with surgery, but given his inoperable cancer, a palliative team was involved. Acknowledging his very poor prognosis, the patient requested discharge to home with home hospice. As reported in the literature, pneumopericardium is rare, and gastro-pericardial fistula associated with gastric cancer is even rarer. Clinical presentation is variable and can be confusing. Providers should be aware of how a patient with gastric cancer can be complicated with pneumopericardium, and they should have a lower threshold of suspicion in patients having risk factors. CT scan is the most sensitive tool for diagnosis.
PubMed: 37378126
DOI: 10.7759/cureus.39358 -
Cureus May 2023Radiofrequency ablation (RFA) is a minimally invasive cardiac catheterization procedure employed in patients whose atrial fibrillation (AF) is not well-controlled on...
Radiofrequency ablation (RFA) is a minimally invasive cardiac catheterization procedure employed in patients whose atrial fibrillation (AF) is not well-controlled on medical therapy. While serious complications after the RFA are uncommon, we present the unique case of a 71-year-old male who suffered from acute respiratory distress syndrome (ARDS) and pneumomediastinum post-procedure. He presented to the ED with dyspnea, non-massive hemoptysis, and fever three days following RFA. Admission CT thorax demonstrated patchy ground glass opacities (GGOs) and stable fibrotic changes. He was admitted for suspected pneumonia, however, he failed to significantly improve on broad-spectrum antibiotics. Bronchoscopy found blood in proximal airways, however, lavage with serial aliquots were without worsening hemorrhage, ruling out suspected diffuse alveolar hemorrhage. Cytology resulted in rare iron polymorphonuclear neutrophils and no malignant cells. With worsening clinical status, the patient was eventually intubated. Repeat CT thorax showed new moderate pneumopericardium, small pneumomediastinum, and progressed GGOs. The respiratory course continued to worsen, and the patient passed away approximately one month after admission. We also present a brief literature review with the aim of identifying prognostic risk factors regarding post-RFA ARDS development. Additionally, this case identifies a novel complication of RFA, as post-procedural pneumomediastinum has not been previously described.
PubMed: 37323324
DOI: 10.7759/cureus.39052 -
Marked hemopneumopericardium in a patient with rectal cancer with distant metastasis: a case report.Journal of Medical Case Reports Jun 2023Hemopneumopericardium defines a condition of combined pathology of weakened, dense blood content (hemopericardium) and air (pneumopericardium) in the pericardial cavity...
INTRODUCTION
Hemopneumopericardium defines a condition of combined pathology of weakened, dense blood content (hemopericardium) and air (pneumopericardium) in the pericardial cavity with an air fluid level. It is a rare disease, with only one such case reported in the literature. In this case report, we assessed a patient rectal cancer in addition to hemopneumopericardium, dyspnea, and chest pain.
CLINICAL CASE REPORT
A 47-year-old Arab woman previously diagnosed with rectal cancer metastasized to bones, lymph nodes, and lungs post-Hartmann procedure reported to the emergency department complaining of worsening dyspnea for 2 weeks, more significantly in the supine position. A productive cough with yellowish sputum characterized this; however, there was no pertinent family or psychological history. Examination of the respiratory system revealed dullness on the left side associated with decreased breath sound. The chest radiograph also revealed marked hydro-pneumopericardium. Spiral computed tomography angiography of pulmonary arteries demonstrated pericardial effusion with the air fluid level at pericardial space, implying hydro-pneumopericardium.
CLINICAL CONCLUSION
A successful pericardiocentesis was performed, in which 180 cc of blood-filled pericardial fluid was drained, suggesting the presence of hemopneumopericardium. Hemopneumopericardium has multiple etiologies, yet critical intervention is restricted in patients with cardiac tamponade. Hence, pericardiocentesis could be a definitive treatment.
Topics: Female; Humans; Middle Aged; Pneumopericardium; Pericardial Effusion; Cardiac Tamponade; Dyspnea; Rectal Neoplasms
PubMed: 37264442
DOI: 10.1186/s13256-023-03935-9 -
CMAJ : Canadian Medical Association... May 2023
Topics: Humans; Pneumopericardium; Pericardium
PubMed: 37220925
DOI: 10.1503/cmaj.221137-f -
Cureus Apr 2023Pneumopericardium (PPC) is a clinical entity defined by the presence of air in the pericardial sac. It occurs mainly in patients who sustain blunt or penetrating chest...
Pneumopericardium (PPC) is a clinical entity defined by the presence of air in the pericardial sac. It occurs mainly in patients who sustain blunt or penetrating chest trauma and may coexist with pneumothorax, hemothorax, rib fractures, and pulmonary contusions. Although it is a strong indicator of cardiac injury and therefore requires immediate attention for possible surgical treatment, it still remains a commonly misdiagnosed condition in the trauma bay. Only a few cases of isolated PPC associated with penetrating chest trauma have been reported to date. We present the case of a 40-year-old man who was stabbed in the anterior chest, specifically in the left subxiphoid area and left forearm. Imaging, which included chest x-ray, chest computed tomography, and cardiac ultrasound, demonstrated the presence of rib fractures in addition to isolated PPC, with no pneumothorax or active bleeding. The patient was managed conservatively and actively monitored for three days and remained hemodynamically stable upon discharge. PPC is an uncommon clinical entity, suggestive of severe thoracic trauma. Clinical features may include chest discomfort and dyspnea, while asymptomatic patients have also been reported. Since it can be monitored by electrocardiograms and cardiac ultrasound, its presence is not an absolute indicator for surgical intervention, while the treatment plan should be based on the patient's clinical indications and symptoms.
PubMed: 37153308
DOI: 10.7759/cureus.37071