Emergency Cervical Mediastinotomy for Massive Mediastinal Emphysema

RYDELL, JOHN R.

doi:10.1001/archsurg.1955.01270110019004

Cited by 18 publications

(6 citation statements)

References 7 publications

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“…In severe cases, it can compress the trachea and requires emergency intervention [18]. Various approaches have been described, including the use of subcutaneous incisions, needles, or drains [3][4][5][6]9]. Cervical mediastinotomy is another option and used when these interventions do not relieve increasing respiratory distress [19].…”

Section: Discussionmentioning

confidence: 99%

“…Its management should begin with a concerted effort to identify the offending cause of the subcutaneous dissection of air [3]. Various approaches have been described, including the use of subcutaneous incisions, needles, drains, or cervical mediastinotomy [3][4][5][6]. Two infraclavicular incisions are our option when these interventions do not relieve increasing respiratory distress.…”

Section: Introductionmentioning

confidence: 99%

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Classification and Management of Subcutaneous Emphysema: a 10-Year Experience

et al. 2013

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Subcutaneous emphysema (SE) is a condition often causing minimal symptoms, but sometimes it can be severe and even life-threatening. This study is the first great survey about SE. The aim of this study is to classify and evaluate the etiology, signs, symptoms, and management of SE. This retrospective study was performed by reviewing patients who had been diagnosed as having SE in Rasht, between January 2001 and January 2011. We classified the severity of SE in five grades including the (1) base of the neck, (2) all of the neck area, (3) subpectoralis major area, (4) chest wall and all of the neck area, and (5) chest wall, neck, orbit, scalp, abdominal wall, upper limbs, and scrotum. We excluded all patients in grades 1 and 2, because the symptoms and signs were not significant. Statistical analysis was carried out with SPSS 18. We collected 35 cases of SE with the mean age of 53±14.83 (71 % men). The most common cause of SE was pneumothorax with background of COPD and surgery in grade 5, trauma due to rib fracture in grade 4, and iatrogenicity in grade 3. We performed two bilateral 2-cm infraclavicular incisions. In our patients with infraclavicular incisions, expansion of the lung was better, and the patients' appearance improved. Infraclavicular incisions as a simple method for the management of SE can decrease the severity of SE with no cosmetic problem.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Classification and Management of Subcutaneous Emphysema: a 10-Year Experience

et al. 2013

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“…Since the occurrence of surgical emphysema may present an additional hazard to the airway, early awareness of the possibility of this complication is important. Careful clinical and radiographic monitoring is, therefore, required, and if necessary, the mediastinum can be decompressed by needle aspiration [4], even by a cervical mediastinotomy [21]. It is important that mediastinal emphysema is also recognized early and the surgeon is aware of potential complications, as the condition may progress to obstruct the upper airway [1,8], induce pneumothorax [9] and cardiac failure [11], or act as a pathway for spread of infection [6,16,23].…”

Section: Discussionmentioning

confidence: 99%

Surgical emphysema following an isolated mandible fracture

Mutaf¹,

Sensoz²,

Üstüner³

et al. 1993

Eur J Plast Surg

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“…Subcutaneous emphysema is defined as air presence in the subcutaneous tissues; it usually starts in the upper part of the body but could expand to virtually the whole body and into deeper soft tissues (2). It is generally regarded as a benign condition (3), however it can pose a significant amount of discomfort to the patient and in rarer cases it has been reported to cause high airway pressure, severe respiratory acidosis, pacemaker malfunction, airway compromise and be associated with tension phenomena, not to mention the risk of superimposed mediastinal infection, which in itself could be life threatening (4).…”

Section: Aetiologymentioning

confidence: 99%

Postoperative subcutaneous emphysema: prevention and treatment

Lodhia¹,

Tenconi²

2021

Shanghai Chest

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Post-operative subcutaneous (or surgical) emphysema (POSE) affects approximately six percent of patients undergoing thoracic surgery. Pre-operative forced expiratory volume in 1 second (FEV 1 ) and lung diffusion capacity for carbon monoxide (DLCO) poorer than 50% of predicted, the presence of adhesions and a post-operative air leak are predictive factors for post-operative subcutaneous emphysema. POSE leads to increased patient distress, dyspnoea, empyema and prolonged length of stay (LOS). The management of this condition should aim at ensuring that the lung is fully expanded through adequate drainage of the chest cavity, in order to expedite sealing of the parenchymal tear. This may require the use of low-pressure suction (−20 cmH 2 O) and pleurodesis techniques. Symptomatic relief can be achieved with sub-cutaneous drains or by applying negative pressure dressing [vacuum assisted closure (VAC) pump]. A small percentage of patients (approximately 1%) require a further surgical procedure to control the air leak.

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Emergency Cervical Mediastinotomy for Massive Mediastinal Emphysema

Cited by 18 publications

References 7 publications

Classification and Management of Subcutaneous Emphysema: a 10-Year Experience

Classification and Management of Subcutaneous Emphysema: a 10-Year Experience

Surgical emphysema following an isolated mandible fracture

Postoperative subcutaneous emphysema: prevention and treatment

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