CT-guided catheter drainage of loculated thoracic air collections in mechanically ventilated patients with acute respiratory distress syndrome.

Chon, Kenneth S.; vanSonnenberg, Eric; D'Agostino, H B; O'Laoide, Risteard; Colt, Henri G.; Hart, Eric

doi:10.2214/ajr.173.5.10541116

Cited by 26 publications

(21 citation statements)

References 25 publications

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“…A more sound use of CT consists of the identification of complications, mainly due to high end-expiratory pressure during ventilation, in CT-guided drainage of loculated air collections [55] and in providing prognostic information. In patients with ARDS/DAD, CT predictors of mortality are .80% of lung involvement, enlargement of the right atrium or development of traction varicoid bronchiectasis [9,56].…”

Section: Acute Respiratory Distress Syndrome | M Zompatori Et Almentioning

confidence: 99%

Overview of current lung imaging in acute respiratory distress syndrome

2014

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Imaging plays a key role in the diagnosis and follow-up of acute respiratory distress syndrome (ARDS). Chest radiography, bedside lung ultrasonography and computed tomography scans can provide useful information for the management of patients and detection of prognostic factors. However, imaging findings are not specific and several possible differential diagnoses should be taken into account. Herein we will review the role of radiological techniques in ARDS, highlight the plain radiological and computed tomography findings according to the pathological stage of the disease (exudative, inflammatory and fibroproliferative), and summarise the main points for the differential diagnosis with cardiogenic oedema, which is still challenging in the acute stage. @ERSpublications ARDS diagnosis is still based on radiological criteria; the variety of these findings should be known and recognised

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Section: Acute Respiratory Distress Syndrome | M Zompatori Et Almentioning

confidence: 99%

Overview of current lung imaging in acute respiratory distress syndrome

2014

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“…Pleural lines may be obscured by adjacent parenchymal disease. Pleural adhesions and differences in compliance in ARDS lungs may cause some segments of the lung to collapse, whereas other segments appear normal or overinflated [64,67,68]. Hence, the presence of lung markings beyond the pleural line does not exclude pneumothoraces in ARDS patients.…”

Section: Radiologic Presentation Of Pneumothoraces In Ardsmentioning

confidence: 99%

“…However, nonstandard placement locations may be required if the lung is extensively adhered to the pleura. Blind surgical chest tube thoracostomy may traverse normal lung and cause further injury or may miss the loculated pneumothorax [64]. Furthermore, these patients are poor candidates for video-assisted thoracostomy for thoracostomy tube placement, since the need for single-lung ventilation and general anesthesia makes operative intervention more risky [72].…”

Section: Tube Thoracostomymentioning

confidence: 99%

Pneumothorax in Patients With Acute Respiratory Distress Syndrome: Pathophysiology, Detection, and Treatment

Woodside¹,

vanSonnenberg

Chon

et al. 2003

J Intensive Care Med

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Pneumothorax is a frequent and potentially fatal complication of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). Prompt recognition and treatment of pneumothoraces is necessary to minimize morbidity and mortality. The radiologic and clinical signs of pneumothoraces in ARDS patients may have unusual and subtle features. Furthermore, small pneumothoraces in these patients can cause severe hemodynamic or pulmonary compromise. Sparse clinical literature exists on when or how to treat pneumothoraces once they develop in patients with ARDS. In this article, the authors review the pathogenesis, radiologic signs, clinical significance, and treatment of pneumothoraces in ARDS patients. Treatment options include traditional tube thoracostomy, open thoracotomy, and image-guided percutaneous catheters.

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“…The traditional treatment for pneumothorax in mechanically ventilated patients has been chest tube thoracostomy [61] , an image-guided small catheter whose size ranges from 7 to 10 Fr, to become an effective therapeutic option for pneumothorax [63] . A retrospective review of 62 ventilated patients who underwent small-bore chest tube drainage as the primary management of pneumothorax found a 68.6% success rate, defined as no residual air seen in the follow-up chest radiograph, and with no major complications [64] .…”

Section: Treatment and Preventionmentioning

confidence: 99%

Iatrogenic pneumothorax related to mechanical ventilation

Hsu¹

2014

WJCCM

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ral space prevents sonographic visualization of visceral pleura movements. Mechanically ventilated patients with a pneumothorax require tube thoracostomy placement because of the high risk of tension pneumothorax. Small-bore catheters are now preferred in the majority of ventilated patients. Furthermore, if there are clinical signs of a tension pneumothorax, emergency needle decompression followed by tube thoracostomy is widely advocated. Patients with pneumothorax related to mechanical ventilation who have tension pneumothorax, a higher acute physiology and chronic health evaluation Ⅱ score or PaO2/FiO2 < 200 mmHg were found to have higher mortality.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Barotrauma; Complication; Critical care; Mechanical ventilation; PneumothoraxCore tip: Patients with pneumothorax related to mechanical ventilation (PRMV) have a high mortality rate. PRMV often occurs in the early stage of mechanical ventilation and it may recur on the other side of lung in a short period of time. Low compliance is associated with a high incidence of PRMV, with PRMV being more related to the underlying process than the ventilatory setting. PRMV patients with tension pneumothorax, higher acute physiology and chronic health evaluation score or PaO2/FiO2 < 200 mmHg have a higher mortality.Hsu CW, Sun SF. Iatrogenic pneumothorax related to mechanical ventilation.

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CT-guided catheter drainage of loculated thoracic air collections in mechanically ventilated patients with acute respiratory distress syndrome.

Cited by 26 publications

References 25 publications

Overview of current lung imaging in acute respiratory distress syndrome

Overview of current lung imaging in acute respiratory distress syndrome

Pneumothorax in Patients With Acute Respiratory Distress Syndrome: Pathophysiology, Detection, and Treatment

Iatrogenic pneumothorax related to mechanical ventilation

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