A 60-year-old man with advanced esophageal cancer was admitted for surgical placement of a feeding jejunostomy tube before commencement of chemoradiotherapy. His esophageal cancer had directly invaded the posterior tracheal wall, inducing a nearly total obstruction of the distal trachea. On the day before the surgery, respiratory failure developed due to tumor progression and tracheal edema. Tracheal intubation and mechanical ventilation were attempted without success. Application of veno-venous extracorporeal membrane oxygenation (ECMO) corrected the patient's respiratory acidosis and relieved his dyspnea. With full ECMO support, he underwent tracheal stent insertion. Two hours later, he was weaned from ECMO support uneventfully. This was a successful case of tracheal stenting for airway obstruction under rescue veno-venous ECMO.
Acidosis, Respiratory ; Airway Management ; Airway Obstruction ; Chemoradiotherapy ; Dyspnea ; Edema ; Emergencies* ; Esophageal Neoplasms* ; Extracorporeal Membrane Oxygenation ; Humans ; Intubation ; Jejunostomy ; Middle Aged ; Respiration, Artificial ; Respiratory Insufficiency ; Stents ; Trachea ; Tracheal Stenosis

A 60-year-old man with advanced esophageal cancer was admitted for surgical placement of a feeding jejunostomy tube before commencement of chemoradiotherapy. His esophageal cancer had directly invaded the posterior tracheal wall, inducing a nearly total obstruction of the distal trachea. On the day before the surgery, respiratory failure developed due to tumor progression and tracheal edema. Tracheal intubation and mechanical ventilation were attempted without success. Application of veno-venous extracorporeal membrane oxygenation (ECMO) corrected the patient's respiratory acidosis and relieved his dyspnea. With full ECMO support, he underwent tracheal stent insertion. Two hours later, he was weaned from ECMO support uneventfully. This was a successful case of tracheal stenting for airway obstruction under rescue veno-venous ECMO.
Acidosis, Respiratory ; Airway Management ; Airway Obstruction ; Chemoradiotherapy ; Dyspnea ; Edema ; Emergencies ; Esophageal Neoplasms ; Extracorporeal Membrane Oxygenation ; Humans ; Intubation ; Jejunostomy ; Middle Aged ; Respiration, Artificial ; Respiratory Insufficiency ; Stents ; Trachea ; Tracheal Stenosis

BACKGROUND AND OBJECTIVES: As indications for tracheotomy have evolved over the decades, the trends in the pediatric tracheotomy also have changed. The purpose of this study is to review the clinical courses and outcomes in the current pediatric tracheotomy. MATERIALS AND METHOD: A retrospective study was performed on 42 pediatric patients who underwent tracheotomies at Ajou University Hospital from June, 1994 to May, 2004. Charts were reviewed with respect to indications for tracheotomy, underlying diseases, success rate in decannulation and length of support time until decannulation, complication and mortality rate. RESULTS: There were 34 (81.0%) male patients and 8 (19.0%) female patients. Ventilatory support for neurological impairment (47.6%) was the leading indication for tracheotomy, followed by upper airway obstruction (19.0%), prolonged intubation due to respiratory failure (16.7%), cervical trauma (7.1%), craniofacial abnormalities (4.8%) and vocal cord palsy (4.8%). Convulsive disorder (19.0%) and congenital neurological malformation (14.3%) were the most common underlying diseases. Decannulation was accomplished in 70.0% of children with an average of 254.5 days with tracheotomy. The length of support time until decannulation was significantly greater in the neurological impairment group than in the other group. Complications occurred in 19.0% without tracheotomy-related death. CONCLUSION: Tracheotomy is relatively safe in the pediatric population as conservative therapy and its outcomes are thought to be usually related to the underlying disease and age.
Airway Obstruction ; Child ; Craniofacial Abnormalities ; Female ; Humans ; Intubation ; Male ; Mortality ; Respiratory Insufficiency ; Retrospective Studies ; Tracheotomy* ; Vocal Cord Paralysis

Prolonged intubation of the trachea in the treatment of acute respiratory failure has become commonplace in the Intensive Care Units during the last decade. We defined prolonged endotracheal intubation as cases in which endotracheal intubation is required more than 7 days, and then experiences 202 caaes out of 5,866 Intensive Care Unit patients from March 1981 to February 1986 in Severance Hospital, Yonsei Medical Complex were evaluated. The results were as follows ; 1) The number of patients were 202 cases in total, and male and females were 130 and 69 cases. The teen-age groups was most common,69 crises(33.7%) and fortiea was 35 cases (17.3%) . 2) The patients of internal medioine department was the mast common, 23.3% and pediatric an? neurosurgical department fellowed in order. 3) The moat common causes of acute respiratory failure is central nervous srstem disotraders and ARDS (Adult Respiratory Distress Syndrome) . 4) Average stay in Intensive Care Unit was 23.5 day, from 3 to 208 days. Nintr-nine cases(49%) were impreved and the remainder (103 caaes) were expired. 5) Orotracheal intubation is performed in 144 cases (71.4%) and tracheostomy was done in 48 cased, among them, in 39 crises oro-and nasotracheal intubation was changed to trac: heostomy after 12 days. 6) Oro-or nasotracheal tube was changed 2.5 timers every 6,3 days. Mean intubation and tracheostomy days was 15.5 and 76.3 darts. 7) Ventilatory support was maintained in 199 caaeg and 12.1 days in endotraeheal intubation patients and 29.1 days in tracheostomy patients. 8) Complication developed in 29 cased awang them 10 cases were in oro- or nasotracheal intubation patients and 19 cartes were in tracheoatomr patients. Horseness, laryngeal edema, and sore throat were deueloped in 3,2 and 1 cartes, respectively, in orotracheal intubation patients and granuloma, traoheal stenosis, tracheal ulceration, an? vocal cord palsy were developed in 9,5,2, and 2 cartes, respectively, in traoheoatomy patents. From the above results, it can be concluded that tracheal complication was serious for the patients who required ventilatory support under prolonged endotracheal incubation. So we must try to Prevent the complication which develop after prolonged endotracheal intu- bation 7nd maintaining the pationts with cardio-respiratory support.
Female ; Granuloma ; Humans ; Intensive Care Units ; Intubation ; Intubation, Intratracheal* ; Laryngeal Edema ; Male ; Pharyngitis ; Respiratory Insufficiency ; Trachea ; Tracheal Stenosis ; Tracheostomy ; Ulcer ; Vocal Cord Paralysis

Hantavirus pulmonary syndrome(HPS) is a systemic disease that is caused by a newly discorved and characterized virus of the Hantavirus genus, which is most frequently referred to as the sin nombre virus. The clinical syndrome resembles other hantavirus syndromes worldwide, except that it is characterized by a brief prodromal illness followed by rapidly progressive, noncardiogenic edema, and that it is more deadly than any previously recognized hantavirus infection. The clinical manifestations of HPS are characterized by four clinical phases prodrome, pulmonary edema and shock, diuresis, and convalescence. Mortality is greatest in the first 24 hours of the pulmonary edema and shock phase of the illness. These phases are strikingly similar to the clinical phases of Hemorrhagic fever with renal syndrome(HFRS) induced by Hantaan virus, except that HPS has not been associated with renal failure and Disseminated intravascular coagulation(DIC). We here report a case of hantavirus pulmonary syndrome developed in a 58 year-old man. He had a flu-like illness followed by the rapid onset of respiratory failure due to noncardiogenic pulmonary edema. HPS was diagnosed by clinical manifestations, identification of high titer antibody to Hantaan virus antigen and histologic finding of transbronchial lung biopsy (TBLB) specimen. The patient was treated with mechanical ventilation and initial corticosteroid pulse therapy resulting in successful outcome.
Biopsy ; Convalescence ; Diuresis ; Edema ; Fever ; Hantaan virus ; Hantavirus Infections ; Hantavirus Pulmonary Syndrome* ; Hantavirus* ; Humans ; Lung ; Middle Aged ; Mortality ; Pulmonary Edema ; Renal Insufficiency ; Respiration, Artificial ; Respiratory Insufficiency ; Shock ; Sin Nombre virus

Lateral medullary infarction can lead to central respiratory failure. However, in Wallenberg's syndrome, obstructive respiratory failure rarely develops. Here, we report a case of obstructive respiratory failure with stridor caused by unilateral lateral medullary infarction. A 74-year-old woman was admitted for acute right lateral medullary infarction. On the 12th day after the stroke, the patient developed respiratory failure necessitating endotracheal intubation. She could maintain good oxygen saturation and ventilation in intubated status without the assistance of mechanical ventilator, even during sleep. The pharyngo-laryngoscopy demonstrated the hypomobility of bilateral vocal cords. This case suggests that unilateral medullary infarction might be a cause of bilateral vocal cord palsy.
Aged ; Airway Obstruction ; Brain Stem Infarctions ; Female ; Humans ; Infarction ; Intubation, Intratracheal ; Lateral Medullary Syndrome ; Medulla Oblongata ; Oxygen ; Respiratory Insufficiency ; Respiratory Sounds ; Stroke ; Ventilation ; Ventilators, Mechanical ; Vocal Cord Paralysis ; Vocal Cords

Hemorrhagic fever with renal syndrome (HFRS) caused by Hantann virus or Seoul virus frequently occurs in Korea. The prodromal clinical symptoms are flu-like symptoms. Rapidly progressive renal failure and hemorrhage follow. Hantavirus pulmonary syndrome (HPS) is usually found in the U.S.A., caused by the Sin-nombre virus. The prodromal symptoms resemble HFRS. However, during the third to fith hospital day after admission, pulmonary edema or pulmonary hemorrhage acutely develops, which results in acute respiratory failure. We here report a case of HFRS with HPS that developed in a 47 year-old man. The patient had flu-like symptoms and diarrhea on admission. Acute renal failure developed and acute hemodialysis was performed. On the fourth hospital day, an asymmetric bilateral haziness as seen on a chest X-ray rapidly developed with reduced O2 saturation, and mechanical ventilation was applied. On the eighth hospital day, the patient was weaned from the ventilator. When acute respiratory failure develops in patients with HFRS, HPS might be considered.
Acute Kidney Injury ; Diarrhea ; Hantavirus Pulmonary Syndrome* ; Hantavirus* ; Hemorrhage ; Hemorrhagic Fever with Renal Syndrome* ; Humans ; Korea ; Middle Aged ; Prodromal Symptoms ; Pulmonary Edema ; Renal Dialysis ; Renal Insufficiency ; Respiration, Artificial ; Respiratory Insufficiency ; Seoul virus ; Thorax ; Ventilators, Mechanical

Diaphragmatic eventration is a rare disease and is caused by congenital etiology. We operated on a patient who had had preexisting left diaphragmatic eventration which was complicated by a right diaphragmatic paralysis and a persistent respiratory insufficiency due to a traffic accident. This was a very rare case and there has not yet been any case reports worldwide. We were able to abtain good surgical results from plication of left diaphragm in this case and thus report it.
Accidents, Traffic ; Diaphragm ; Diaphragmatic Eventration* ; Humans ; Rare Diseases ; Respiratory Insufficiency ; Respiratory Paralysis*

Obesity hypoventilation syndrome (OHS) is characterized by severe obesity, excessive daytime sleepiness, hypoxemia and hypercapnea. Because OHS mimics pulmonary hypertension or cor pulmonale, clinicians should recognize and treat this syndrome appropriately. A 58-year-old female visited the emergency room because of dyspnea. She was obese and had kyphoscoliosis. The patient also experienced snoring, recurrent choking during sleep and daytime hypersomnolence which worsened after gaining weight in the recent year. The arterial blood gas analysis showed she experienced hypoxemia and hypercapnea not only during nighttime but also daytime. We suspected OHS and the patient underwent polysomnography to confirm whether obstructive sleep apnea was present. During the polysomnography test, sleep obstructive apnea was observed and apnea-hypopnea index was 9.2/hr. The patient was treated with bilevel positive airway pressure therapy (BiPAP). After BiPAP for 4 days, hypoxemia and hypercapnia were resolved and she is currently well without BiPAP. We report a case successfully treated with clinical improvement by presuming OHS early in a patient who had typical OHS symptoms, even while having other conditions which could cause hypoventilation.
Airway Obstruction ; Anoxia ; Apnea ; Blood Gas Analysis ; Disorders of Excessive Somnolence ; Dyspnea ; Emergency Service, Hospital ; Female ; Humans ; Hypercapnia ; Hypertension, Pulmonary ; Hypoventilation ; Middle Aged ; Obesity Hypoventilation Syndrome* ; Obesity, Morbid ; Polysomnography ; Pulmonary Heart Disease ; Sleep Apnea, Obstructive ; Snoring

Sjogren syndrome is a chronic autoimmune disease characterized by lymphocytic infiltration of exocrine glands resulting in dry mouth and eyes. Approximately one-third of patients present with systemic manifestations, but respiratory muscle involvements have been rarely reported. We report a case of acute respiratory failure complicated by primary Sjogren syndrome. Muscle biopsy revealed perivascular lymphocytic infiltrations. Corticosteroid therapy improved respiratory muscle weakness. Sjogren syndrome should be considered as one of the underlying diseases causing acute respiratory failure.
Autoimmune Diseases ; Biopsy ; Exocrine Glands ; Humans ; Mouth ; Muscular Diseases ; Respiratory Insufficiency ; Respiratory Muscles* ; Respiratory Paralysis ; Sjogren's Syndrome*