Intensive Care Med (2015) 41:327–328 DOI 10.1007/s00134-014-3508-0
Alessandro Marchioni Riccardo Fantini Federico Antenora Paolo Corradini
IMAGING IN INTENSIVE CARE MEDICINE
An uncommon cause of weaning failure from mechanical ventilation
Received: 23 September 2014 Accepted: 24 September 2014 Published online: 7 October 2014 Ó Springer-Verlag Berlin Heidelberg and ESICM 2014 A. Marchioni ()) R. Fantini F. Antenora P. Corradini Respiratory Diseases Clinic, Azienda Ospedaliero-Universitaria, Policlinico via del Pozzo, 71, 41124 Modena, Italy e-mail: [email protected] Tel.: ?39.059.4225859
A 70-year-old man with a history of surgery for thoracic aortic aneurysm arrived at the emergency department with shortness of breath and wheezing. The chest radiograph showed no parenchymal lesions, while gas analysis was consistent with acute hypercapnic respiratory failure.
As a result of the patient’s rapid clinical deterioration, endotracheal intubation was performed and mechanical ventilation was started in pressure controlled ventilation (PCV) mode. A subsequent CT scan of the chest showed a severe reduction in the diameter of distal trachea and of both main bronchi by the extrinsic compression of a recurrent aneurysm of the descending thoracic aorta (Fig. 1a, b). We therefore performed a bronchoscopy which confirmed the presence of severe stenosis of distal trachea and of both main bronchi without alteration of the bronchial mucosa (Fig. 2a). Owing to his clinical condition and previous surgery for aneurysm, the patient was judged to be inoperable by the vascular surgery team. After several failed attempts at weaning from mechanical ventilation, we performed tracheobronchial stent placement with rigid bronchoscopy restoring the lumen of the trachea and both main bronchi (Fig. 2). After the
Fig. 1 a CT scan of the chest shows stenosis of the distal third of the trachea secondary to extrinsic compression by an aneurysm of the descending aorta. b Compression extends to both main bronchi causing a tight stenosis
328
procedure it was possible to perform extubation without complications and the patient was discharged from the ICU a few days later. Financial disclosure The authors have no financial involvement with any organization or entity with a financial interest in competition with the subject, matter or materials discussed in the manuscript. Informed consent publication.
Fig. 2 a Bronchoscopy showing the carina and stenosis from compression of both main bronchi. b Control after bronchoscopic placement of tracheobronchial stents, highlighting the restoration of patency of the trachea and of both main bronchi
The patient gave his informed consent for
Alessandro Marchioni Riccardo Fantini Federico Antenora Paolo Corradini
IMAGING IN INTENSIVE CARE MEDICINE
An uncommon cause of weaning failure from mechanical ventilation
Received: 23 September 2014 Accepted: 24 September 2014 Published online: 7 October 2014 Ó Springer-Verlag Berlin Heidelberg and ESICM 2014 A. Marchioni ()) R. Fantini F. Antenora P. Corradini Respiratory Diseases Clinic, Azienda Ospedaliero-Universitaria, Policlinico via del Pozzo, 71, 41124 Modena, Italy e-mail: [email protected] Tel.: ?39.059.4225859
A 70-year-old man with a history of surgery for thoracic aortic aneurysm arrived at the emergency department with shortness of breath and wheezing. The chest radiograph showed no parenchymal lesions, while gas analysis was consistent with acute hypercapnic respiratory failure.
As a result of the patient’s rapid clinical deterioration, endotracheal intubation was performed and mechanical ventilation was started in pressure controlled ventilation (PCV) mode. A subsequent CT scan of the chest showed a severe reduction in the diameter of distal trachea and of both main bronchi by the extrinsic compression of a recurrent aneurysm of the descending thoracic aorta (Fig. 1a, b). We therefore performed a bronchoscopy which confirmed the presence of severe stenosis of distal trachea and of both main bronchi without alteration of the bronchial mucosa (Fig. 2a). Owing to his clinical condition and previous surgery for aneurysm, the patient was judged to be inoperable by the vascular surgery team. After several failed attempts at weaning from mechanical ventilation, we performed tracheobronchial stent placement with rigid bronchoscopy restoring the lumen of the trachea and both main bronchi (Fig. 2). After the
Fig. 1 a CT scan of the chest shows stenosis of the distal third of the trachea secondary to extrinsic compression by an aneurysm of the descending aorta. b Compression extends to both main bronchi causing a tight stenosis
328
procedure it was possible to perform extubation without complications and the patient was discharged from the ICU a few days later. Financial disclosure The authors have no financial involvement with any organization or entity with a financial interest in competition with the subject, matter or materials discussed in the manuscript. Informed consent publication.
Fig. 2 a Bronchoscopy showing the carina and stenosis from compression of both main bronchi. b Control after bronchoscopic placement of tracheobronchial stents, highlighting the restoration of patency of the trachea and of both main bronchi
The patient gave his informed consent for
