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Tube Feedings Formulas and Methods
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
The placement of an NGT of any type can cause nose bleeds and aspiration. In roughly 2% of cases, NG tubes are accidentally placed within the bronco pulmonary system (Rassias, Ball, and Corwin 1998). Pneumothorax has been reported. After prolonged intubation, NGTs can cause sinusitis, ulcerations and abscess. NGTs are frequently dislodged due to accidental pulling on the tube by the patient or staff.
Thoracic trauma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Pneumothorax and hemothorax are the second most common thoracic injuries. In about two-thirds of cases, these injuries are associated with significant additional thoracic and non-thoracic injury. Pneumothorax may be due to injury to the chest wall, lung parenchyma, tracheobronchial tree, or esophagus. Pneumothorax and hemothorax may be asymptomatic or present with respiratory distress, chest pain, failure to maintain oxygen saturation, tenderness of the chest wall, crepitus from subcutaneous emphysema, decreased air entry on the affected side, and tracheal deviation to the unaffected side. Simple pneumothorax has the propensity to progress to tension pneumothorax due to the relatively mobile mediastinum in children, while a large hemothorax may not be immediately recognized and result in hemorrhagic shock. This is especially true in younger children in whom the clinical features of hypotension are often masked until the time of catastrophic decompensation. It is important to note that each hemithorax may hold up to 40% of a child's total blood volume.
Lung volume reduction − old and new approaches
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Nathaniel Marchetti, Gerard Criner
Although EBV placement is associated with less morbidity than LVRS, there are significant complications associated with the procedure. The two most common complications include AECOPD and pneumothorax. Table 43.3 lists the rates for these complications for the RCTs that enrolled patients with intact fissures. Most studies have reported a pneumothorax rate of 25%–34% (51–55,57,58). The REACH trial did have fewer episodes of pneumothorax compared to other reports (53). Although the reason for this finding is not clear, the investigators suggest that it may be due to conservative post-procedure care (6-day hospitalization and bed rest), less emphysema in ipsilateral lobe relative to treatment lobe or possibly due to lack of experience with EBV placement, since there was less TLVR compared to other trials. Most, but not all, of the pneumothoraces required placement of a chest tube, and there are published guidelines on when valves should be removed or if surgical intervention is required (59). Mortality does occur following EBV placement, and the largest trial to date had mortality rate of 3.1%, with most of the mortality associated with pneumothorax (52). The majority of pneumothoraces occur within the first few days, and for this reason patients are usually admitted to hospital following the procedure for 3 or 4 days to monitor for development of pneumothorax. Other complications that have been reported include haemoptysis, valve migration/expectoration, pneumonia and formation of granulation tissue.
Point-of-care ultrasound for diagnosis of pneumothorax in a pregnant COVID-19 patient in the emergency department
Published in Journal of Obstetrics and Gynaecology, 2022
Muge Gulen, Salim Satar, Nurdan Unlu, Cemre Ipek Esen, Mehmet Bozkurt, Sarper Sevdimbas, Selen Acehan
Spontaneous pneumothorax is a rare but very serious complication in patients with COVID-19 pneumonia. Although the mechanism of pneumothorax occurrence is not fully understood, it is thought that it may develop due to the diffuse alveolar damage caused by pneumonia, interstitial emphysema, bullae or alveolar rupture caused by persistent cough (Vega et al. 2020). Its timing is uncertain, and it may be the first admission complaint of patients (Abootalebi et al. 2021); it may also develop during outpatient follow-up (González-Pacheco et al. 2021) or hospitalisation (Martinelli et al. 2020). According to the conducted studies, the incidence of pneumothorax in COVID-19 patients was 1% in those who need to be hospitalised, 2% in those who need to be hospitalised in the intensive care unit (ICU), and 15% in those who had mechanical ventilation requirement. Pneumothorax was found in 1% of patients who died due to COVID-19 pneumonia (Martinelli et al. 2020). However, no pneumothorax case associated with COVID-19 positivity in a pregnant patient has been reported in the literature.
Applications of cryobiopsy in airway, pleural, and parenchymal disease
Published in Expert Review of Respiratory Medicine, 2022
Andrew DeMaio, Jeffrey Thiboutot, Lonny Yarmus
With development of a 1.1 mm cryoprobe, cryobiopsy has also been utilized in a similar fashion with the EBUS bronchoscope to provide larger specimens for pathologic evaluation and increase diagnostic yield. In fact, a recent trial has investigated the use of conventional EBUS-TBNA versus EBUS-cryobiopsy using a 1.1 mm cryoprobe [102]. All patients underwent both EBUS-TBNA and EBUS-cryobiopsy sequentially, with the order of sampling randomized. The overall diagnostic yield was higher in samples obtained by EBUS-cryobiopsy versus TBNA (91.8% vs. 79.9%, p = 0.001). The diagnostic yield was similar for metastatic adenopathy, but higher in both uncommon tumors (91.7% vs 25.0%, p = 0.001) and benign disorders (80.9% vs 53.2%, p = 0.004). No major complications were reported, although there were two instances of pneumothorax and one instance of pneumomediastinum reported. There is potentially increased risk with this approach compared to EBUS-TBNA, especially if vascular nodes or those near large vessels are sampled. Notably, accessing lymph nodes with the cryoprobe required using an electrocautery knife to make a small incision in the bronchial wall prior to facilitate passage of the cryoprobe.
Risk prediction of pneumothorax in lung malignancy patients treated with percutaneous microwave ablation: development of nomogram model
Published in International Journal of Hyperthermia, 2021
Sheng Xu, Jing Qi, Bin Li, Zhi-Xin Bie, Yuan-Ming Li, Xiao-Guang Li
A total of 552 LM patients (402 in the training cohort and 150 in the validation cohort; Figure 1) with 614 MWA procedures (494 patients with one procedure, 54 patients with two procedures and four patients with three procedures) in the mean follow-up of 3.6 ± 2.8 months were enrolled in this study, comprising 338 males (61.2%) and 214 females (38.8%). Detailed demographic characteristics are presented in Table 1. A total of 154 patients (27.9%) developed pneumothorax after MWA. Of these, 104 patients (18.8%) had immediate pneumothorax and 50 (9.1%) had delayed pneumothorax, with a mean time to delayed pneumothorax of 4.2 ± 6.3 d. For the management of pneumothorax, 72/154 (46.8%) patients received intercostal tube placement (56 in training cohort and 16 in validation cohort) and 23/154 (14.9%) patients received manual evacuation (14 in training cohort and 9 in validation cohort). All patients recovered from the pneumothorax.