Acute and Critical Care

Cardiology/Pulmonary
Successful Rescue Therapy with Pumpless Extracorporeal Carbon Dioxide Removal in a Patient with Persistent Air Leakage due to Empyema: Jaeyoung Cho, Yeon Joo Lee, Jae-Ho Lee, Choon-Taek Lee, Young-Jae Cho; Korean J Crit Care Med. 2017;32(3):284-290. Published online November 14, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00185

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Abstract PDF: A young metastatic lung cancer patient developed empyema due to an infection with carbapenem-resistant Acinetobacter baumannii. Hydropneumothorax was detected and managed by a tube thoracotomy. However, persistent air leakage through the chest tube was observed due to the presence of a bronchopleural fistula (BPF). As hypercapnic respiratory failure had progressed and the large air leak did not diminish by conservative management, a pumpless extracorporeal lung assist (pECLA) device was inserted. The pECLA allowed the patient to be weaned from mechanical ventilation and the BPF to heal. The present case shows the effective application of pECLA in a patient with empyema complicated with BPF and severe hypercapnic respiratory failure. pECLA enabled us to minimize airway pressure to aid in the closure of the BPF in the mechanically ventilated patient.

Occurrence of Acquired Tracheoesophageal Fistula Due to Excess Endotracheal Tube Cuff Volumes: A Case Report: Myeong Soo Kim, Eun Jeong Koh, Ha Young Choi; Korean J Crit Care Med. 2013;28(2):146-151.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.146

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Endotracheal tube cuff volume and pressure require constant monitoring to prevent tracheal injury. Acquired tracheoesophageal fistula is common from complications of mechanical ventilation as a result of pressured necrosis of the tracheoesophageal wall by endotracheal tube cuff. It still represents a life-threatening condition, especially when the diagnosis is being delayed. We present our modest experience through an acquired TEF patient who had an excessively enlarged cuff diameter on chest radiogram in order to consider the potential of using radiological-measured cuff diameter as a simple technique for predicting tracheal damages. Although the cuff pressure was monitored with a manometer by the medical team, it was possible that the tube cuff was excessively enlarged. Proper procedures for preventing the tracheal damage by cuffs include the following: monitoring of endotracheal cuff pressure and volume, observation of cuff size on the chest radiogram, and being mindful and attentive for possibilities of misjudgements by manometer or medical teams.

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The Morphometric Study of Main Bronchus in Korean Cadaver
Ik Sung Kim, Chang Ho Song
Korean Journal of Physical Anthropology.2017; 30(1): 7. CrossRef
Total Unilateral Obstruction by Sputum Immediately after Tracheal Bougienage
Kyunam Kim, Jonghun Jun, Miae Jeong, Songlark Choi, Youngsun Lee
Korean Journal of Critical Care Medicine.2014; 29(1): 32. CrossRef

Esophageal-Retroesophageal Right Subclavian Artery Fistula: A Case Report: Jin Ho Choi, Chun Sung Byun, Seong Min Kim, Jung Joo Hwang; Korean J Crit Care Med. 2012;27(3):179-181.; DOI: https://doi.org/10.4266/kjccm.2012.27.3.179

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Abstract PDF: Fistula between retroesophageal subclavian artery and esophagus is rare but a fatal complication. The purpose of this case study is to describe a case of 47-year old male presented with intracranial hemorrhage being required a long stay in the intensive care unit and to demonstrate the importance of surveillance patients requiring prolonged nasogastric tube. Recognition of this aberrant artery is critical for the prevention of these catastrophic events.

Two Cases of Postintubation Tracheoesophageal Fistula in Patients with a History of Tracheostomy: Case Report: Seung Chan Kim, Kyung Won Ha, Joon Ho Wang, Se Jin Kim, Won Hak Kim, So Hee Jeong, Woo Sung Lee, Sang Don Han, Gyu Rak Chon; Korean J Crit Care Med. 2009;24(2):87-91.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.87

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Common causes of acquired tracheoesophageal (T-E) fistula are blunt trauma on the neck or chest, malignancy, long-term mechanical ventilation, and post-intubation injury. Most of the cases are fatal due to severe respiratory infection. We experienced two cases of post-intubation T-E fistula in patients with a history of tracheostomy that developed earlier than usual. One case was caused by excessive cuff pressure and the other by avulsion injury during endotracheal intubation. We can get instructions from these cases that how to prevent T-E fistula because it is hard to treat and causes severe outcomes.

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Occurrence of Acquired Tracheoesophageal Fistula Due to Excess Endotracheal Tube Cuff Volumes - A Case Report -
Myeong Soo Kim, Eun Jeong Koh, Ha Young Choi
Korean Journal of Critical Care Medicine.2013; 28(2): 146. CrossRef
Acquired Tracheoesophageal Fistula through Esophageal Diverticulum in Patient Who Had a Prolonged Tracheostomy Tube - A Case Report -
Jae Hwan Jung, Ji Sung Kim, Yong Kyun Kim
Annals of Rehabilitation Medicine.2011; 35(3): 436. CrossRef

Atelectasis of Dependent Lungs during Fistula Closure in a Patient with Tracheopleural Fistula: A Case Report: Hong Soo Jung, Yeon Soo Jeon, Jin Woo Choi, Jin Deok Joo, Yong Shin Kim, Dae Woo Kim, Jang Hyeok In, Joo Seon Park; Korean J Crit Care Med. 2009;24(2):106-110.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.106

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Abstract PDF: Atelectasis is a fairly common complication in patients undergoing general anesthesia. However, atelectasis caused secretion plugs in patients with tracheopleural fistula is less common than other airway fistulas such as trachea and bronchus. Anesthesiologists should make every effort for thorough preoperative preparation to prevent atelectasis and using appropriate and aggressive treatment, including tracheal or bronchial clearing and end expiratory positive pressure. We report a case of an intraoperative occurrence of atelectasis of the lower lobe of a dependent lung in a patient with a tracheopleural fistula during single lung ventilation for primary closure.

A Case of Respiratory Failure Caused by Gastropleural Fistula: A Case Report: Woo Hyun Cho, Dong Yup Ryu, Sung Yik Lee, Bo Hyun Kim, Yun Seong Kim; Korean J Crit Care Med. 2005;20(2):183-186.

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Abstract PDF: Gastropleural fistula is a very rare disorder, caused by various conditions, such as trauma and postoperative complication, subphrenic abscess, malignancy, hiatal hernia. The major causes of the gastropleural fistula have changed from trauma and subphrenic abscess to postoperative complication of malignant disorders. We report a case of empyema that developed respiratory failure caused by gastropleural fistula in a middle age woman with review of related articles.

Tracheoesophageal Fistula as a Complication after Endotracheal Intubation: A Case Report: Woong Mo Kim, Seong Wook Jeong, Sang Hyun Kwak, Sung Su Chung, Chang Young Jeong; Korean J Crit Care Med. 2003;18(1):39-42.

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Abstract PDF: Placement of endotracheal tube, even for extremely short periods, can result in injury to laryngeal and tracheal tissue. This may be clinically insignificant, but in rare cases, it could be life threatening and results in permanent disability. Especially, tracheoesophageal fistula (TEF) is a serious and challenging problem because it may contaminate the tracheobronchial tree and interfere with nutrition. This uncommon but lethal complication has been reported to be associated with certain risk factors in tracheally intubated patients, and better knowledge of these factors could reduce the incidence of post-intubation TEF. We report a case of 49-year old male patient who has acquired TEF caused by endotracheal intubation and positive pressure ventilation.

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