Acute and Critical Care

Pulmonary
Negative Pressure Pulmonary Hemorrhage after Laryngospasm during the Postoperative Period: In Soo Han, Bo Mi Han, Soo Yeon Jung, Jun Rho Yoon, Eun Yong Chung; Acute Crit Care. 2018;33(3):191-195. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2016.00689

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Negative pressure pulmonary hemorrhage (NPPH) is an uncommon complication of upper airway obstruction. Severe negative intrathoracic pressure after upper airway obstruction can increase pulmonary capillary mural pressure, which results in mechanical stress on the pulmonary capillaries, causing NPPH. We report a case of acute NPPH caused by laryngospasm in a 25-year-old man during the postoperative period. Causative factors of NPPH include negative pulmonary pressure, allergic rhinitis, smoking, inhaled anesthetics, and positive airway pressure due to coughing. The patient’s symptoms resolved rapidly, within 24 hours, with supportive care.

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A Complex Presentation of Acute Postoperative Negative-Pressure Pulmonary Edema: A Case Report and Review of Literature
Larri Rudman, Javier B Chambi-Torres, Farah Chohan, Mohammad Aftab, Xinyu Cao, George Michel
Cureus.2023;[Epub] CrossRef
Laryngospasm Causing Recurrent Negative Pressure Alveolar Hemorrhage Resembling Acute Exacerbation of Interstitial Lung Disease: A Case Report
Haruna Yamaki, Masaru Ejima, Nozomi Sato, Kei Aoyagi, Tatsushi Kozawa, Seishi Higashi, Koji Takayama, Satoko Hanada, Reiko Taki
Respiratory Endoscopy.2023; 1(2): 95. CrossRef
Unilateral pulmonary hemorrhage caused by negative pressure pulmonary edema: A case report
Hyung Joon Park, Seung Ho Park, Un Tak Woo, Sang Yun Cho, Woo Jae Jeon, Woo Jong Shin
World Journal of Clinical Cases.2021; 9(6): 1408. CrossRef
Negative-pressure-related diffuse alveolar hemorrhage after monitored anesthesia care for vertebroplasty: a case report
Yumin Jo, Jagyung Hwang, Jieun Lee, Hansol Kang, Boohwi Hong
Journal of Medical Case Reports.2021;[Epub] CrossRef
Incidence of negative-pressure pulmonary edema following sugammadex administration during anesthesia emergence: A pilot audit of 27,498 general anesthesia patients and literature review
Chia-Li Kao, Chuan-Yi Kuo, Yi-Kai Su, Kuo-Chuan Hung
Journal of Clinical Anesthesia.2020; 62: 109728. CrossRef

Pulmonary
Acute Respiratory Failure due to Alveolar Hemorrhage after Exposure to Organic Dust: Sun Mi Choi, Jiwon Koh, Sang-Min Lee, Jinwoo Lee; Korean J Crit Care Med. 2016;31(2):173-177. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.173

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Abstract PDF: Diffuse alveolar hemorrhage (DAH) is associated with severe outcomes. We report a case of acute respiratory failure that required mechanical ventilation and was clinically and pathologically diagnosed as DAH related to exposure to organic dust. A 39-year-old man, who had visited a warehouse to grade beans for purchase, was referred to our hospital for impending respiratory failure. His initial radiographic examinations revealed diffuse bilateral ground-glass opacities in his lungs and bronchoalveolar lavage resulted in progressively bloodier returns, which is characteristic of DAH. He underwent bedside open lung biopsy of his right lower lobe in the intensive care unit. Biopsy results revealed DAH and organization with accumulation of hemosiderin-laden macrophages and a few fibroblastic foci. The patient was treated with empirical antibiotics and high-dose corticosteroids and successfully weaned from mechanical ventilation. DAH might be considered in the differential diagnosis of patients with acute respiratory failure after exposure to organic particles.

Pulmonary
Barotrauma after Manual Ventilation in a Patient with Life-Threatening Massive Hemoptysis: Hea Yon Lee, Yu Young Joo, Young Seung Oh, Yoo Rim Seo, Hyon Soo Joo, Seok Chan Kim, Chin Kook Rhee; Korean J Crit Care Med. 2015;30(4):308-312. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.308

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A 36-year-old female patient with aplastic anemia developed massive hemoptysis and was placed on ventilator support. However, airway obstruction by blood clots triggered desaturation and ventilator malfunction. Manual ventilation was initiated to improve oxygenation, and emergency flexible bronchoscopy was performed to clear the airway. Nevertheless, the patient developed extensive subcutaneous emphysema, pneumothorax, and pneumomediastinum.

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Clinical Approach to Massive Hemoptysis: Perioperative Focus on Causes and Management
Timothy Weiquan Toh, Jacqueline Hui Fen Goh, Sui An Lie, Carrie Kah Lai Leong, Nian Chih Hwang
Journal of Cardiothoracic and Vascular Anesthesia.2024; 38(10): 2412. CrossRef
Pathophysiology and Prevention of Manual-Ventilation-Induced Lung Injury (MVILI)
Luke A. White, Steven A. Conrad, Jonathan Steven Alexander
Pathophysiology.2024; 31(4): 583. CrossRef
Experimental validation of a portable tidal volume indicator for bag valve mask ventilation
Benjamin S. Maxey, Luke A. White, Giovanni F. Solitro, Steven A. Conrad, J. Steven Alexander
BMC Biomedical Engineering.2022;[Epub] CrossRef

Cardiology/Pulmonary
Massive Hemoptysis due to Acute Mitral Regurgitation with Sporadic Primary Mitral Valve Prolapse: Won Young Chae, Sun Jin Park, Chi Woo Song, Byoung Hoon Lee, Sang Hoon Kim, Jae Hyung Lee; Korean J Crit Care Med. 2015;30(3):202-206. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.202

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The most common cardiac cause of massive hemoptysis is mitral stenosis. Mitral regurgitation is rarely complicated by massive hemoptysis. A 48-year-old man with no significant medical history was admitted to our hospital with hemoptysis and production of 500 mL of blood within 24 hours. A pan-systolic murmur was found on chest examination. A chest computed tomography showed airspace consolidation in the right upper and middle lobes, with faint bilateral ground glass opacity. Echocardiography revealed mitral valve prolapse and grade IV mitral regurgitation. The patient was diagnosed with sporadic primary mitral valve prolapse. After mitral valve repair surgery, the patient recovered fully.

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Hemoptysis and Unilateral Pulmonary Infiltrates due to Severe Acute Mitral Regurgitation from Papillary Muscle Rupture
Joanna Wieckowska, Nicholas Diloreto, Shannon Hood, Isabella Chojnacki, Dalia Zakri, Antonio Corrado
Case Reports in Pulmonology.2024; 2024: 1. CrossRef
Surgically‐treated hemoptysis and alveolar hemorrhaging resulting from severe mitral regurgitation: A case report
Daisuke Yamaguchi, Toshiya Tokui, Takahiro Narukawa, Masahiko Murakami, Tomotake Sekoguchi, Ryosai Inoue, Koji Hirano, Yasumi Maze, Hisato Ito
Clinical Case Reports.2023;[Epub] CrossRef
Acute mitral valve regurgitation causing severe alveolar hemorrhage
Ayaka Sakamoto, Yuki Enomoto, Hiroaki Watabe, Yasuaki Koyama, Yukei Matsumoto, Nobutake Shimojo, Aiki Marushima, Satoru Kawano, Yoshiaki Inoue
Acute Medicine & Surgery.2020;[Epub] CrossRef
Man With Sudden Dyspnea and Hemoptysis
Naoki Kawakami, Rina Kato, Chushu Liu, Kazuhiko Takahashi, Yoko Wakai, Kazuhito Saito
Annals of Emergency Medicine.2020; 75(5): 668. CrossRef

Pulmonary
Diffuse Alveolar Hemorrhage Confirmed by Bronchoalveolar Lavage in a Patient with Hemoptysis after Sildenafil Use for Erectile Dysfunction: Kyoung Min Moon, Sun Young Jung, Min Soo Han, Yongseon Cho, Young Min Rah, Jong Woo Kim; Korean J Crit Care Med. 2015;30(1):31-33. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.31

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Abstract PDF

A 81-year-old man was referred for respiratory failure by emergency medical technicians. He admitted at intensive care unit for ventilator treatment. Several hours before admission, he took sildenafil 100 mg for erectile dysfunction without prescription. The episodes of hemoptysis occurred several hours later. Computed tomography revealed multifocal diffuse ground-glass attenuation in both lungs. And the more we performed bronchoalveolar lavage, the more the color of it was turned into red. We treated him with empirical antibiotics and tranexamic acid, and hemoptysis was stopped in one day after admission. But in the 5th admission day, he died from sepsis combined with pneumonia caused by Acinetobacter baumannii abruptly.

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Transient haemoptysis after taking sildenafil
Suheyla Karaduman, Azmaeen Zarif, Alesia Talpeka, Muhammed Haseeb
BMJ Case Reports.2024; 17(7): e258050. CrossRef

Extracorporeal Membrane Oxygenation as a Rescue Therapy in a Patient with Non-Iatrogenic Massive Hemoptysis: Jong Hoo Lee, Su Wan Kim, Yee Hyung Kim; Korean J Crit Care Med. 2013;28(3):225-229.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.225

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Abstract PDF: Despite the advanced technologies of intensive care, massive hemoptysis can still cause death in a small subset of patients. Extracorporeal membrane oxygenation (ECMO) is expected to provide adequate gas exchange, to reduce ventilator-induced lung injuries, and to eventually improve outcomes in these patients. Also, the instability of vital signs due to hemoptysis makes it impossible to perform immediate interventional procedures such as embolization and resectional surgery. In these cases, ECMO may be instituted as a bridge therapy. Herein, we describe the detailed course of our case, with the hopes of helping physicians to decide when to initiate ECMO in patients with massive hemoptysis.

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