Let air out of the bowel to allow more air in the lungs: surgical treatment of weaning failure

Massive colothorax secondary to intestinal pseudo-obstruction: an unusual cause of respiratory failure

“…The diagnosis of colothorax and diaphragmatic herniation should be considered within the wider differential of acute respiratory failure, particularly where recent surgery has been performed. Definitive management is by intestinal decompression (which may be achieved percutaneously in refractory cases6) and surgical repair of the underlying defect (either congenital or acquired), though was not feasible in this patient owing to the degree of clinical instability.…”

Extrathoracic hyperinflation

“…Indeed, plethysmograph tends to count as TGV any air that is within the thoracic cage as it is compressed by the panting manoeuver 1. We usually think that only the air volume being above the diaphragm is counted but in case of diaphragmatic hernia, hiatal hernia2 or major colonic dilation,3 subdiaphragmatic air being forced up into the thoracic cage is also taken into account. In the present case, TGV measured both intrathoracic gases, which increased after colonic exsufflation, and subdiaphragmatic gases, decreased by exsufflation, resulting in a non-significant change in TGV.…”