1/16. acinetobacter calcoaceticus pneumonia and the formation of pneumatoceles.Pneumatoceles are cystic lesions of the lungs often seen in children with staphylococcal pneumonia and positive-pressure ventilation. acinetobacter calcoaceticus is an aerobic, short immobile gram-negative rod, or coccobacillus, which is an omnipresent saprophyte. The variant anitratus is the most clinically significant pathogen in this family, usually presenting as a lower respiratory tract infection. Acinetobacter has been demonstrated to be one of the most common organisms found in the ICU. We present three critically ill surgery patients with Acinetobacter pneumonia, high inspiratory pressures, and the subsequent development of pneumatoceles. One of these patients died from a ruptured pneumatocele, resulting in tension pneumothorax. Treatment of pneumatoceles should center on appropriate intravenous antimicrobial therapy. This should be culture directed but is most often accomplished with imipenem. Percutaneous, computed tomographic-guided catheter placement or direct tube thoracostomy decompression of the pneumatocele may prevent subsequent rupture and potentially lethal tension pneumothorax.- - - - - - - - - - ranking = 1keywords = positive-pressure (Clic here for more details about this article) |
2/16. Management of tension pneumatocele with high-frequency oscillatory ventilation.We report the successful application of high-frequency oscillatory ventilation in a patient with tension pneumatocele (TP). The proposed check-valve mechanism for the development of pneumatoceles predicts that positive-pressure ventilation could lead to distension of these airspaces and formation of TPs. Therefore, high-frequency ventilation could be more applicable in conditions, such as massive air leak due to bronchopleural fistula, that are difficult to manage by conventional ventilator modes.- - - - - - - - - - ranking = 1keywords = positive-pressure (Clic here for more details about this article) |
3/16. Spontaneous pneumothorax secondary to radiographically occult lung metastasis from parapharyngeal synovial sarcoma: report of a case.This report describes a case of secondary pneumothorax caused by a radiographically occult lung metastasis from parapharyngeal synovial sarcoma, a relatively rare tumor known to be highly metastatic to the lung. Although chest X-ray and thoracic computed tomography scan failed to detect the metastatic nodule in the right lung, the surgically resected specimen proved to be a 3-mm lung metastasis. To our knowledge, only eight cases of lung metastases from synovial sarcoma causing pneumothorax have ever been reported. In most of these cases, the lung metastases were detected by radiographical examinations. However, in this patient, the metastatic lesion was not detected during examination. It is speculated that secondary pneumothorax caused by synovial sarcoma may occur during the early stages of lung metastasis. Therefore, if pneumothorax occurs in a patient with a synovial sarcoma, the possibility of lung metastasis should be carefully considered, even if it is undetectable on radiological examinations.- - - - - - - - - - ranking = 0.00066039967354421keywords = occult (Clic here for more details about this article) |
4/16. The point of the needle. Occult pneumothorax: a review.The case of a patient with an unusual medical condition and an occult pneumothorax is presented. The evidence for management of occult pneumothorax particularly in patients with underlying lung disease is reviewed and solutions to the acute clinical problems that may arise are suggested.- - - - - - - - - - ranking = 0.00026415986941768keywords = occult (Clic here for more details about this article) |
5/16. An open question.The lungs are surrounded by the pleural membranes. The visceral pleura directly covers the lung and is separated from the parietal pleura by a layer of surfactant, which reduces friction during respiratory movement. A potential space exists between these two layers, and they may become separated by fluid or air. A lung can collapse to the size of a fist under pressure from either. Standard treatment in the field for an open chest wound is an occlusive dressing. The first thing that can be used to occlude the wound is a gloved hand. After placing the dressing, evaluate the breath sounds and determine if they have improved. The dressing should be taped down on three sides, leaving one side open to relieve the pressure during exhalation (one-way valve). "Burping" the dressing involves lifting one side to make sure any pressure buildup is relieved, as occasionally the dressing can become adhered to the skin, which may lead to a tension pneumothorax. If, after ensuring the occlusive dressing is properly in place, the respiratory rate increases, distress level worsens, oxygen saturations fall and breath sounds decrease, then needle decompression is required. A neurovascular bundle is located underneath each rib, and it is important to avoid damage to that bundle by performing a decompression over the top of a rib. If the patient is intubated before the development of a tension pneumothorax, carefully evaluate the breath sounds (especially if the left-side sounds are diminished) to determine if the ET tube needs to be withdrawn a centimeter. The rescuer performing ventilation will usually recognize a tension pneumothorax by the difficulty in bagging the patient. Remember, when you perform a needle thoracentesis, you are creating an open chest wound. Early signs and symptoms of a tension pneumothorax include diminished or absent breath sounds, severe dyspnea, narrowing pulse pressure, tachycardia and restlessness. neck veins may be distended, but this can be a normal finding in a supine patient. The classic sign is a deviated trachea; the trachea shifts toward the "good" lung as the buildup of pressure collapses the "bad" lung. This is a late sign and suggests the tension pneumothorax has been developing for some time. One sign that does not normally accompany a plain pneumothorax is hypotension. In this case, the persistent low BP, combined with cool, mottled skin and a delayed capillary refill time, led providers to suspect that a hemothorax was developing as well. With endotracheal intubation and pleural decompression, the positive-pressure ventilations allowed the affected right lung to inflate more fully, utilize more of the available alveolar space and "bag out" some of the blood pooling at the base. The patient's vital signs and saturation improved. He needed surgical treatment and removal of the blood in the pleural space before ventilation and oxygenation could normalize.- - - - - - - - - - ranking = 1keywords = positive-pressure (Clic here for more details about this article) |
6/16. Airway pressure release ventilation in a patient with acute pulmonary injury.Airway pressure release ventilation is a recently described method of ventilatory support. It allows spontaneous ventilation with CPAP but differs from conventional ventilatory modes because, with APRV, peak inflation pressure never exceeds the level of CPAP, and airway pressure decreases, rather than increases, when tidal volume is delivered. The risk of pulmonary barotrauma and adverse hemodynamic effects associated with conventional modes of positive-pressure mechanical ventilation may be decreased because of lower peak inflation and mean airway pressures. We describe a patient in whom several risk factors for these complications were present who was treated successfully with APRV.- - - - - - - - - - ranking = 1keywords = positive-pressure (Clic here for more details about this article) |
7/16. Pulmonary complications following endotracheal intubation for anesthesia in breech extraction.A 28-year-old, healthy pregnant patient developed bilateral pneumothorax, subcutaneous emphysema, pneumomediastinum, pneumoretroperitoneum and pneumoperitoneum following endotracheal intubation and manual ventilation during general anesthesia for breech extraction. It is likely that positive-pressure ventilation was the cause for this very rare combination of complications. Early recognition and treatment may prevent such a catastrophe.- - - - - - - - - - ranking = 1keywords = positive-pressure (Clic here for more details about this article) |
8/16. Bronchopleural leakage treated with fibrin sealant and high-frequency positive-pressure ventilation.In a 62-year-old man, left spontaneous pneumothorax appeared 14 days after right pneumonectomy. The large air leakage necessitated thoracotomy and resection of a bullous area in the left upper lobe. Pleurectomy was not performed. The air leakage continued for 14 more days until, at a second left thoracotomy, numerous bullae were oversewn and covered with fibrin sealant. High-frequency positive-pressure ventilation (90 respirations/min, 21 l/min) was used for the following 6 hours. After 18 hours there was no more air leakage during spontaneous ventilation and the patient made a good recovery.- - - - - - - - - - ranking = 5keywords = positive-pressure (Clic here for more details about this article) |
9/16. "Bleb" carcinoma of the lung.The association of peripheral carcinoma of the lung with pre-existing parenchymal scars is widely known. Since blebs are usually associated with subpleural scars, it is surprising that the clinical association of peripheral carcinoma and blebs has received scant attention in the surgical literature. Four surgical cases which illustrate this association are presented. This does not imply that large bullae require exploration or excision to exclude a possible occult carcinoma, but it is reasonable to conclude that any parenchymal lesion in association with large bullae in older patients should be viewed with more than ordinary suspicion of carcinoma.- - - - - - - - - - ranking = 0.00013207993470884keywords = occult (Clic here for more details about this article) |
10/16. Extralobar pulmonary sequestration. Unusual presentation and systemic vascular communication in association with a right-sided diaphragmatic hernia.A 17-day-old infant with a right-sided extralobar pulmonary sequestration associated with an intact diaphragmatic hernia sac presented as an acute respiratory emergency. The diagnosis was obscured by the initial resuscitative treatment of cardiorespiratory arrest necessitating positive-pressure ventilation complicated by bilateral tension pneumothoraces prior to transfer. At operation, unique systemic arterial and venous communications to the sequestration from the dome of the liver through the intact hernia sac were found. A bronchial communication to the right main bronchus was also present. Histologic examination of the sequestration specimen revealed other features common to both intralobar and extralobar sequestration. This case lends support to the hypothesis of a common embryologic basis for both types of sequestration, as well as other congenital pulmonary cystic abnormalities, and the association with diaphragmatic hernia.- - - - - - - - - - ranking = 1keywords = positive-pressure (Clic here for more details about this article) |
| | Next -> |