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Bronchoscopy AND ECMO

Nao Umei, Shingo Ichiba
The mortality rate for respiratory failure resulting from obesity hypoventilation syndrome is high if it requires ventilator management. We describe a case of severe acute respiratory failure resulting from obesity hypoventilation syndrome (BMI, 60.2 kg/m(2)) successfully treated with venovenous extracorporeal membrane oxygenation (VV-ECMO). During ECMO management, a mucus plug was removed by bronchoscopy daily and 18 L of water was removed using diuretics, resulting in weight loss of 24 kg. The patient was weaned from ECMO on day 5, extubated on day 16, and discharged on day 21...
2017: Case Reports in Critical Care
Christian Biancosino, Marcus Krüger, Christian Kühn, Norman Zinne, Michaela Wilhelmi, Christian Zeckey, Christian Krettek, Martin Gathen
Complex tracheobronchial injuries, especially if both main bronchi are involved, are life threatening and their diagnosis and successful treatment concerning short-term as well as long-term results are most challenging. This is the first report on a successful reconstruction of a complex bilateral bronchial injury under extracorporeal membrane oxygenation (ECMO) support. We present the course from prehospital treatment, establishment of ECMO in the emergency room to initial bronchoscopy, operative reconstruction, and intensive care therapy...
August 2016: Annals of Thoracic Surgery
Silvia Chacón-Alves, Jose Luis Pérez-Vela, Teodoro Grau-Carmona, Helena Domínguez-Aguado, Helena Marín-Mateos, Emilio Renes-Carreño
Pulmonary endarterectomy (PEA) is the treatment of choice to relieve pulmonary artery obstruction in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We present a patient with airway obstruction and acute respiratory failure due to large blood clots obstructing the trachea and main left bronchus. This condition was accompanied by right ventricle failure and cardiogenic shock. A venoarterial ECMO system was used for cardiopulmonary support before extracting the clots and clearing the airway by rigid bronchoscopy...
July 4, 2016: International Journal of Artificial Organs
Harrison T Pitcher, Meredith A Harrison, Colette Shaw, Scott W Cowan, Hitoshi Hirose, Nicholas Cavarocchi
BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is a life-saving procedure in patients with both respiratory and cardiac failure. Bleeding complications are common since patients must be maintained on anticoagulation. Massive hemoptysis is a rare complication of ECMO; however, it may result in death if not managed thoughtfully and expeditiously. METHODS: A retrospective chart review was performed of consecutive ECMO patients from 7/2010-8/2014 to identify episodes of massive hemoptysis...
May 25, 2016: Perfusion
Q Ballouhey, R Fesseau, V Benouaich, S Lagarde, S Breinig, B Léobon, P Galinier
INTRODUCTION: Tracheobronchial rupture (TBR) due to blunt chest trauma is a rare but life-threatening injury in the pediatric age group. The aim of this study was to propose a treatment strategy including bronchoscopy, surgery and extracorporeal membrane oxygenation (ECMO) to optimize the emergency management of these patients. METHODS: We reviewed a series of 27 patients with post-traumatic TBR treated since 1996 in our pediatric trauma center. RESULTS: Seven cases had persistent and large volume air leaks...
April 2013: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Nirmal S Sharma, Timothy Peters, Tejaswini Kulkarni, Charles W Hoopes, Scott C Bellot, Keith M Wille, Enrique Diaz-Guzman
BACKGROUND: Previous studies have demonstrated the safety of flexible bronchoscopy (FB) in mechanically ventilated subjects. However, the safety of FB in adult subjects receiving extracorporeal membrane oxygenation (ECMO) has not been described previously. METHODS: A retrospective review was conducted of all adult subjects who underwent FB while receiving ECMO support at the University of Alabama at Birmingham Hospital from January 1, 2013, to December 31, 2014...
May 2016: Respiratory Care
Nirmal S Sharma, Keith M Wille, S Christopher Bellot, Enrique Diaz-Guzman
Extracorporeal membrane oxygenation (ECMO) has been used to provide "lung rest" through the use of low tidal volume (6 ml/kg) and ultralow tidal volume (<6 ml/kg) ventilation in acute respiratory distress syndrome (ARDS). Low and ultralow tidal volume ventilation can result in low dynamic respiratory compliance and potentially increased retention of airway secretions. We present our experience using automated rotational percussion beds (ARPBs) and bronchoscopy in four ARDS patients to manage increased pulmonary secretions...
May 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Tanmay S Panchabhai, Joseph E Khabbaza, Siva Raja, Atul C Mehta, Umur Hatipoğlu
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) pneumonia is associated with very high mortality. Though surgical evacuation of necrotic tissue is desirable in patients unresponsive to antimicrobial therapy, most patients are acutely ill precluding surgical intervention. We utilized a combination of extracorporeal membrane oxygenation (ECMO) with frequent toilet bronchoscopies to salvage an unaffected right lung from spillage of necrotic pus from left lung cavitary CA-MRSA pneumonia in a 22-year-old patient...
October 2015: Annals of Thoracic Medicine
Philipp Jungebluth, Bernhard Holzgraefe, Mei Ling Lim, Adil Doganay Duru, Vanessa Lundin, Nina Heldring, Oscar P B Wiklander, Joel Z Nordin, Michael Chrobok, Christoph Roderburg, Sebastian Sjöqvist, Björn Anderstam, Antonio Beltrán Rodríguez, Johannes C Haag, Ylva Gustafsson, Katharina G Roddewig, Petra Jones, Matthew J A Wood, Tom Luedde, Ana I Teixeira, Ola Hermanson, Ola Winqvist, Håkan Kalzén, Samir El Andaloussi, Evren Alici, Paolo Macchiarini
BACKGROUND: Acute respiratory distress syndrome (ARDS) is a devastating disorder. Despite enormous efforts in clinical research, effective treatment options are lacking, and mortality rates remain unacceptably high. OBJECTIVES: A male patient with severe ARDS showed no clinical improvement with conventional therapies. Hence, an emergent experimental intervention was performed. METHODS: We performed intratracheal administration of autologous peripheral blood-derived mononuclear cells (PBMCs) and erythropoietin (EPO)...
2015: Respiration; International Review of Thoracic Diseases
Aidan M Hodges, Michael J Gillham, Christopher A Lewis
A bronchopleural fistula (BPF) is a life-threatening complication of cardiothoracic surgery and acute illness. There is no consensus on how best to treat a BPF. Recently, endobronchial one-way valves, designed for bronchoscopic lung volume reduction in emphysema, have been used to treat BPFs. We describe the use of an endobronchial oneway valve, placed at the bedside via flexible bronchoscopy, to treat a BPF in a patient with hypoxic respiratory failure, supported by extracorporeal membrane oxygenation (ECMO), secondary to pneumonia...
September 2015: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Tin Jasinovic, Frederick K Kozak, J Paul Moxham, Mark Chilvers, David Wensley, Michael Seear, Andrew Campbell, Jeffrey P Ludemann
OBJECTIVES: To review clinical presentations and management strategies for children with plastic bronchitis. METHODS: Retrospective chart review. RESULTS: Seven patients required rigid bronchoscopy to remove bronchial casts over a 17-year study period. Mean age at presentation was 60 months. Mean follow-up was 53 months. Co-morbidities included: congenital heart disease (n=3), chronic pulmonary disorders (n=2) and sickle cell disease (n=1)...
October 2015: International Journal of Pediatric Otorhinolaryngology
Narjust Duma, Christian Barlow, Larysa Sanchez, Sean Sadikot
A 61-year-old Caucasian man with hypertension and hepatitis C presented to the emergency department with 7 days of productive cough and low-grade fevers despite outpatient therapy with oral azithromycin. On initial evaluation, he was lethargic with peripheral cyanosis and oxygen saturation in the low 70 s on room air, necessitating endotracheal intubation. Chest imaging revealed diffuse bilateral infiltrates compatible with the diagnosis of acute respiratory distress syndrome. Patient subsequently developed profound hypoxaemia and on day 2 of admission, veno-veno extracorporeal membrane oxygenation (ECMO) was initiated...
2015: BMJ Case Reports
Jae Jun Kim, Seok Whan Moon, Yong Hwan Kim, Si Young Choi, Seong Cheol Jeong
Tracheal tumor is a rare but life-threatening condition that can cause obstruction of the airway. Management of tracheal tumors is very challenging and includes surgical resection, radiotherapy, and therapeutic bronchoscopy. Herein, we present a very rare case of an 88-year-old female patient with a tracheal mass due to direct invasion of a mediastinal teratoma. We devised a new method for resection of the tracheal mass because management of her airway and the tracheal mass by conventional methods was impossible...
March 2015: Journal of Thoracic Disease
Jennifer W Toth, Abigail B Podany, Michael F Reed, Dorothy V Rocourt, Christopher R Gilbert, Mary C Santos, Robert E Cilley, Peter W Dillon
PURPOSE: In children, persistent air leaks can result from pulmonary infection or barotrauma. Management strategies include surgery, prolonged pleural drainage, ventilator manipulation, and extracorporeal membrane oxygenation (ECMO). We report the use of endobronchial valve placement as an effective minimally invasive intervention for persistent air leaks in children. METHODS: Children with refractory prolonged air leaks were evaluated by a multidisciplinary team (pediatric surgery, interventional pulmonology, pediatric intensive care, and thoracic surgery) for endobronchial valve placement...
January 2015: Journal of Pediatric Surgery
Albert H Park, David E Tunkel, Erica Park, Douglas Barnhart, Edward Liu, Justin Lee, Richard Black
OBJECTIVES: Successful removal of an airway foreign body can be very challenging. We present three patients with airway foreign body aspiration successfully treated using extracorporeal membrane oxygenation (ECMO). Their clinical presentation and findings will be reviewed to determine when ECMO should be considered for treatment. STUDY DESIGN: Retrospective multi-institutional review of a case series of patients with airway foreign body who underwent successful treatment using ECMO...
December 2014: International Journal of Pediatric Otorhinolaryngology
Andrew W Choi, John E A Blair, James D Flaherty
We describe a case of a 75-year-old woman presenting emergently with an anterior S-T elevation myocardial infarction that deteriorated into ventricular fibrillation requiring prompt resuscitation, resulting in cardiogenic shock. Emergency primary percutaneous coronary intervention of the left anterior descending coronary artery with adjunctive abciximab and heparin resulted in adequate coronary flow, and intra-aortic balloon pump was used to support hemodynamics. Within one hour of intervention, she developed acute respiratory distress with four-quadrant opacification of lung fields, difficulty with oxygenation, and hypotension...
April 2015: Catheterization and Cardiovascular Interventions
Narjust Perez-Florez, Larysa Gromko, Steven Kim, Sean Sadikot
SESSION TITLE: Cancer Student/Resident Case Report Posters IIISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Lung cancer can have diverse and dramatic presentations. We present a case of a bronchial-esophageal fistula as the initial presentation of lung cancer, resulting in respiratory failure and acute respiratory distress syndrome (ARDS).CASE PRESENTATION: A 61 year-old Caucasian male with hypertension and Hepatitis C presented to the emergency department with 7 days of productive cough and low-grade fevers despite outpatient therapy with oral Azithromycin...
October 1, 2014: Chest
Kristyn Sayball, Thomas Iden, Ray Shepherd, Ehab Hussein
SESSION TITLE: Interstitial Lung Disease Cases IISESSION TYPE: Affiliate Case Report SlidePRESENTED ON: Wednesday, October 29, 2014 at 11:00 AM - 12:15 PMINTRODUCTION: Pulmonary alveolar proteinosis (PAP) is an uncommon disease characterized by varying degrees of dyspnea and hypoxemia. Reports of PAP progressing to respiratory failure requiring mechanical ventilation are rare. CASE PRESENTATION: A previously healthy 31 year old male presented with four months of progressive dyspnea...
October 1, 2014: Chest
Walter James, Lisa Brath, Orlando Debesa
SESSION TITLE: Infectious Disease Cases IISESSION TYPE: Affiliate Case Report SlidePRESENTED ON: Wednesday, October 29, 2014 at 11:00 AM - 12:15 PMINTRODUCTION: Acute Respiratory Distress Syndrome (ARDS) is a disease with significant morbidity, mortality and cost. Pulmonary tuberculosis(TB) causing ARDS is rare. This case report describes a unique case of ARDS secondary to Pulmonary TB that was successfully managed with extracorporeal membrane oxygenation (ECMO). CASE PRESENTATION: A 31 year-old Liberian male was transferred with progressive respiratory failure requiring mechanical ventilation...
October 1, 2014: Chest
Jing-Yang Liou, Lok-Hi Chow, Kwok-Hon Chan, Mei-Yung Tsou
We report a case of large thyroid carcinoma with tracheal and esophageal invasion who presented with preoperative stridor scheduled for total thyroidectomy and segmental tracheal resection. Careful and comprehensive preoperative anesthetic planning was done. Extracorporeal circulation membrane oxygenation (ECMO) was set up and running prior to induction under local anesthesia, due to an increased international normalized ratio (INR) and fear of bleeding in the airway. Fiberoptic bronchoscopy (FOB) is the first choice in many circumstances of difficult airway...
September 2014: Journal of the Chinese Medical Association: JCMA
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