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Journal of Thoracic Disease May 2024Pneumothorax is a rare but serious complication of septic pulmonary embolism (SPE). SPE is a life-threatening disorder wherein infected thrombi bring infarction of the...
BACKGROUND
Pneumothorax is a rare but serious complication of septic pulmonary embolism (SPE). SPE is a life-threatening disorder wherein infected thrombi bring infarction of the terminal and small caliber parts of the pulmonary vasculature and develop multiple nodular and cavitary lesions. Interventions other than conservative chest tube drainage for pneumothorax due to SPE have rarely been reported. Here, we present a case of bilateral pneumothorax due to SPE treated with intrapleural minocycline pleurodesis.
CASE DESCRIPTION
A 72-year-old male patient previously diagnosed as esophageal carcinoma developed metachronous bilateral pneumothorax while treated for brain metastases. Based on blood cultures and chest computed tomography images, he was diagnosed with pneumothorax secondary to SPE due to methicillin-susceptible bacteremia. Bilateral chest tube drainage was instituted. Continuous air leakage was found bilaterally after chest tube placement. He was treated with broad-spectrum antibiotics based on the susceptibility profile and supportive treatment for sepsis. Approximately 3 weeks later, air leakage significantly reduced. We performed intrapleural minocycline pleurodesis bilaterally to prevent the recurrence of pneumothorax; the left side was firstly treated and the right side was treated 2 weeks later. Both chest tubes were successfully removed two days after procedures. Although the patient finally died of brain metastases 1 month after pleurodesis, he never recurred pneumothorax.
CONCLUSIONS
Intrapleural minocycline pleurodesis may be one of the useful and efficacious options in terms of treating intractable pneumothorax associated with SPE. Intrapleural minocycline pleurodesis could be a consideration for intractable pneumothorax related to SPE.
PubMed: 38883652
DOI: 10.21037/jtd-23-1923 -
Acute Medicine & Surgery 2024
PubMed: 38881956
DOI: 10.1002/ams2.971 -
Cognitive aid and performance for simulated umbilical venous catheter placement: A randomized trial.Archives de Pediatrie : Organe Officiel... Jun 2024Neonatal resuscitation may require urgent umbilical venous catheter (UVC) placement. Complications can be observed with umbilical venous catheterization, especially in a...
INTRODUCTION
Neonatal resuscitation may require urgent umbilical venous catheter (UVC) placement. Complications can be observed with umbilical venous catheterization, especially in a stressful context. Inspired by the aeronautic environment, medical routine checklists, also called "cognitive aids," secure the equipment and environment for the patients once they are admitted to the operating room. We hypothesized that reading a cognitive aid for UVC placement in the delivery room during neonatal resuscitation simulation scenarios can (a) improve the performance in reducing catheterization duration and (b) can limit complications.
METHODS
This was a prospective single-center randomized study. A total of 23 dyads for a simulation scenario were included: 12 in the control group and 11 in the cognitive aid group. In the cognitive aid group, the cognitive aid was read by the same facilitator for every scenario.
RESULTS
No significant difference concerning the duration of the procedure was identified between the cognitive aid and control groups: 412 s [342; 420] vs. 374 s [338;402], respectively (p = 0.781). Nevertheless, there were significantly fewer deviations from hygiene guidelines and improved prevention of air embolism in the cognitive aid group compared with the control group.
CONCLUSION
The UVC insertion time was similar between the control and cognitive aid groups. Moreover, cognitive aid can limit infectious complications or air embolism by allowing caregivers to follow UVC placement standards.
PubMed: 38876930
DOI: 10.1016/j.arcped.2024.03.001 -
Medicine Jun 2024Laparoscopic hepatectomy (LH) poses a high risk of carbon dioxide embolism due to extensive hepatic transection, long surgery duration, and dissection of the large...
INTRODUCTION
Laparoscopic hepatectomy (LH) poses a high risk of carbon dioxide embolism due to extensive hepatic transection, long surgery duration, and dissection of the large hepatic veins or vena cava.
PATIENT CONCERNS
A 65-year-old man was scheduled to undergo LH. Following intraperitoneal carbon dioxide (CO2) insufflation and hepatic portal occlusion, the patient developed severe hemodynamic collapse accompanied by a decrease in the pulse oxygen saturation (SpO2).
DIAGNOSIS
Although a decrease in end-tidal carbon dioxide (ETCO2) was not observed, CO2 embolism was still suspected because of the symptoms.
INTERVENTIONS AND OUTCOMES
The patient was successfully resuscitated after the immediate discontinuation of CO2 insufflation and inotrope administration. CO2 embolism must always be suspected during laparoscopic surgery whenever sudden hemodynamic collapse associated with decreased pulse oxygen saturation occurs, regardless of whether ETCO2 changes. Instant arterial blood gas analysis is imperative, and a significant difference between PaCO2 and ETCO2 is indicative of carbon dioxide embolism.
CONCLUSION
Instant arterial blood gas analysis is imperative, and a significant difference between PaCO2 and ETCO2 is indicative of carbon dioxide embolism.
Topics: Humans; Male; Aged; Laparoscopy; Hepatectomy; Embolism, Air; Carbon Dioxide; Insufflation; Blood Gas Analysis; Intraoperative Complications
PubMed: 38875434
DOI: 10.1097/MD.0000000000038468 -
Perfusion Jun 2024The aphorism "Primum non nocere" underscores the responsibility of healthcare professionals to prioritize patient safety. Perfusionists, experts in extracorporeal...
The aphorism "Primum non nocere" underscores the responsibility of healthcare professionals to prioritize patient safety. Perfusionists, experts in extracorporeal circulation, play a pivotal role in maintaining cardiac function during critical situations. However, the evolving landscape of medical technology has not been without challenges, particularly in ensuring equitable access to perfusion training. Easy Flow Cardiopulmonary Bypass Simulation Model stands out as a cost-effective alternative, utilizing routine CPB equipment found in operating theatres. The uniqueness lies in its incorporation of double reservoirs and two pumps, a novel approach not reported before in educational CPB simulation models. The benefits of this model extend beyond skill development to encompass team management, communication enhancement, and disaster management training. Multiple scenarios, from the initiation of CPB to addressing emergencies like massive air embolism, can be simulated. Although the model requires an instructor, this facilitates the integration of essential professional and communication skills into training. The adaptability of the Easy Flow model makes it a practical and sustainable solution. It provides hands-on experience for perfusion students, translating theoretical knowledge into practical competence. The model's simplicity, combined with its use of readily available materials, positions it to be an accessible tool for educational institutions and healthcare centers globally. In conclusion, the Easy Flow CPB Simulation Model not only fills a critical gap in perfusion education but also exemplifies how innovation can bridge disparities, ensuring that quality healthcare education is within reach for all. Its potential impact on global healthcare training is profound, promising a future where knowledge sharing leads to improved patient care.
PubMed: 38859555
DOI: 10.1177/02676591241261017 -
A&A Practice Jun 2024Most of the cases demonstrating describing acute findings using point-of-care ultrasound (POCUS) have been described in emergency medicine and critical care medicine....
Most of the cases demonstrating describing acute findings using point-of-care ultrasound (POCUS) have been described in emergency medicine and critical care medicine. While the use of POCUS has become more prevalent in anesthesia practice, documentation of acute findings resulting in alteration in management based on real-time ultrasound findings during pediatric anesthesia remains limited. This case highlights the use of POCUS during cardiopulmonary collapse occurring during correction of neuromuscular scoliosis. POCUS excluded the presumed diagnosis of venous air embolism and identified an intracardiac thrombus leading to the diagnosis and treatment of pulmonary embolism.
Topics: Humans; Heart Diseases; Point-of-Care Systems; Pulmonary Embolism; Scoliosis; Thrombosis; Ultrasonography; Male; Child
PubMed: 38842207
DOI: 10.1213/XAA.0000000000001796 -
Catheterization and Cardiovascular... Jun 2024The clinical efficacy and safety of a novel left atrial appendage (LAA) occluder of the SeaLA closure system in patients with nonvalvular atrial fibrillation (NVAF) were...
OBJECTIVES
The clinical efficacy and safety of a novel left atrial appendage (LAA) occluder of the SeaLA closure system in patients with nonvalvular atrial fibrillation (NVAF) were reported.
BACKGROUND
Patients with NVAF are at a higher risk of stroke compared to healthy individuals. Left atrial appendage closure (LAAC) has emerged as a prominent strategy for reducing the risk of thrombosis in individuals with NVAF.
METHODS
A prospective, multicenter study was conducted in NVAF patients with a high risk of stroke.
RESULTS
The LAAC was successfully performed in 163 patients. The mean age was 66.93 ± 7.92 years, with a mean preoperative CHA2DS2-VASc score of 4.17 ± 1.48. One patient with residual flow >3 mm was observed at the 6-month follow-up, confirmed by TEE. During the follow-up, 2 severe pericardiac effusions were noted, and 2 ischemic strokes were observed. Four device-related thromboses were resolved after anticoagulation treatment. There was no device embolism.
CONCLUSIONS
The LAAC with the SeaLA device demonstrates encouraging feasibility, safety, and efficacy outcomes.
PubMed: 38841867
DOI: 10.1002/ccd.31056 -
Future Science OA 2024Venous air embolism is a rare but potentially life threatening complication of endoscopic retrograde cholangiopancreatography. Diagnosis is difficult because of the...
Venous air embolism is a rare but potentially life threatening complication of endoscopic retrograde cholangiopancreatography. Diagnosis is difficult because of the lack of specific signs or symptoms. A 62-year-old man underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis. A cardiovascular collapse occurred during the procedure. The echocardiography showed air within the right ventricle. Aspiration of air from the right ventricle was done and saved the patient's life. We highlight through this case that increased awareness is essential for prompt recognition of the air embolism to allow life-saving therapy.
PubMed: 38841180
DOI: 10.2144/fsoa-2023-0174 -
Cureus Apr 2024An air embolism is characterized by the entry of gas bubbles into the circulatory system, which can lead to the possible occlusion of blood vessels, posing a potentially...
An air embolism is characterized by the entry of gas bubbles into the circulatory system, which can lead to the possible occlusion of blood vessels, posing a potentially life-threatening risk. While commonly associated with lung trauma or decompression sickness, it can also result from medical procedures such as central venous catheter insertion or, in our case, gas insufflation for laparoscopic surgery. We present the case of a 65-year-old female who suffered from a stroke secondary to an air embolism after undergoing a laparoscopic Nissen fundoplication in which carbon dioxide insufflation of the abdominal cavity was utilized. We also will discuss the elusive etiology of this complication as well as diagnosis, treatment, and proposed preventative measures. A 65-year-old female with gastroesophageal reflux disease and a hiatal hernia elected to undergo a laparoscopic Nissen fundoplication for hernia repair. After a successful surgery, the patient was found with significant neurological deficits, including left-sided hemiplegia, numbness in the left hand, hemianopsia, dysarthria, and a National Institutes of Health Stroke Scale score of 20. CT head imaging revealed several low-density foci in the right frontal lobe, while CT neck and chest imaging revealed subcutaneous emphysema and pneumomediastinum. Subsequent labs were significant for an elevated lactate at 7.6 mmol/L. MRI of the brain depicted evidence of an acute infarct in the right frontal lobe with diffusion-weighted imaging (DWI) sequences. The imaging results were correlated with the patient's clinical presentation to establish the diagnosis of a nondominant hemisphere stroke, localized to an anterior branch of the right middle cerebral artery (MCA). After intubation and supportive treatment for three days, the patient was extubated and able to follow commands but had left facial weakness and diminished strength in the left upper and lower extremities. At the two-month follow-up visit, the patient no longer had any focal neurological deficits. Air emboli, though very rare, can occur as a complication in laparoscopic surgeries that utilize CO for body cavity insufflation. Patients may be asymptomatic with small, self-limiting emboli, while others may exhibit pulmonary symptoms, cardiac arrest, or focal neurologic changes, depending on the emoji's size and location. Given the wide range of patient presentations, the elevated mortality of laparoscopic procedures complicated by air emboli, and the rare occurrence of focal neurological symptoms as depicted in this case, rapid diagnosis and close postoperative observation and treatment are vital for both short-term and long-term patient outcomes.
PubMed: 38807820
DOI: 10.7759/cureus.59168 -
Circulation. Arrhythmia and... Jun 2024Irrigated radiofrequency ablation with half-normal saline can potentially increase lesion size but may increase the risk of steam pops with the risk of emboli or...
BACKGROUND
Irrigated radiofrequency ablation with half-normal saline can potentially increase lesion size but may increase the risk of steam pops with the risk of emboli or perforation. We hypothesized that pops would be preceded by intracardiac echocardiography (ICE) findings as well as a large impedance fall.
METHODS
In 100 consecutive patients undergoing endocardial ventricular arrhythmia radiofrequency ablation with half-normal saline, we attempted to observe the ablation site with ICE. Radiofrequency ablation power was titrated to a 15 to 20 Ohm impedance fall and could be adjusted for tissue whitening and increasing bubble formation on ICE. Steam pops were defined as audible or a sudden explosion of microbubbles on ICE.
RESULTS
Of 2190 ablation applications in 100 patients (82% cardiomyopathy, 50% sustained ventricular tachycardia), pops occurred during 43 (2.0%) applications. Sites with pops had greater impedance decreases of 18 [14, 21]% versus 13 [10, 17]% (<0.001). ICE visualized 1308 (59.7%) radiofrequency sites, and fewer pops occurred when ICE visualized the radiofrequency ablation site (1.4%) compared with without ICE visualization (2.8%; =0.016). Of the 18 ICE-visible pops, 7 (39%) were silent but recognized as an explosion of bubbles on ICE. With ICE, 89% of pops were preceded by either tissue whitening or a sudden increase in bubbles. In a multivariable model, tissue whitening and a sudden increase in bubbles were associated with steam pops (odds ratio, 7.186; =0.004, and odds ratio, 29.93; <0.001, respectively), independent of impedance fall and power. There were no pericardial effusions or embolic events with steam pops.
CONCLUSIONS
Steam pops occurred in 2% of half-normal saline radiofrequency applications titrated to an impedance fall and are likely under-recognized without ICE. On ICE, steam pops are usually preceded by tissue whitening or a sudden increase in bubble formation, which can potentially be used to adjust radiofrequency application to help reduce pops.
Topics: Humans; Male; Female; Saline Solution; Middle Aged; Catheter Ablation; Tachycardia, Ventricular; Steam; Therapeutic Irrigation; Echocardiography; Aged; Embolism, Air; Treatment Outcome; Risk Factors; Predictive Value of Tests; Electric Impedance
PubMed: 38804141
DOI: 10.1161/CIRCEP.123.012635