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Background: Several reports on organ injury and death due to incorrect chest tube insertion exist; however, reports on the chest tube penetrating the liver and reaching the inferior vena cava are limited. Case Presentation: A 79-year-old man presented with a clamped tube because of massive bleeding from the tube following right chest tube replacement in the hospital of origin. The tube entered the inferior vena cava from the hepatic parenchyma via the right hepatic vein and was removed 15 h later because his hemodynamics stabilized. A ruptured pseudoaneurysm necessitated further transcatheter arterial embolism on the second hospitalization day, and the patient was transferred back to the referring hospital on day 17. Conclusion: Liver injury caused by an inferior vena cava misinsertion-associated chest tube can be treated with elective surgery in anticipation of the tube's tamponade effect. However, due to the risk of rebleeding, imaging follow-up is necessary soon after surgery.
RESUMO
BACKGROUND: Massive hemoptysis causing inadequate ventilation results in life-threatening consequences. We present a patient who developed respiratory insufficiency produced by bronchiectatic massive hemoptysis and underwent prolonged anticoagulation-free veno-venous extracorporeal membrane oxygenation (VV-ECMO) during which thoracic surgeries were performed. CASE PRESENTATION: A 79-year-old woman suffered massive hemoptysis resulting in respiratory failure during fiberoptic bronchoscopy. Bronchial intubation followed by one lung ventilation failed to ensure adequate oxygenation. Anticoagulation-free VV-ECMO, therefore, was installed immediately. Since conservative hemostatic measures including bronchial arterial embolization were not effective, resection of the culprit lung was performed while on VV-ECMO. Next day an exploratory thoracotomy and intercostal artery embolization were needed for recurrent bleeding. The VV-ECMO was withdrawn after five days of operation. CONCLUSIONS: Massive hemoptysis can be fatal and needs instantaneous and intensive treatments. In our case, long-term anticoagulation-free VV-ECMO during which thoracic surgeries and endovascular interventions were performed provided a favorable outcome.
RESUMO
AIM: Extubation failure-associated factors have not been investigated in elderly patients. We hypothesized that psoas cross-sectional area, an emerging indicator of frailty, can be a predictor of extubation outcomes. METHODS: This retrospective study analyzed data from patients admitted between January and April 2016 at the mixed medical intensive care unit (ICU) of the Tokyo Medical University Hospital. Patients were considered eligible if aged 65 years or older, required intubation at the emergency room, and were admitted to ICU for over 24 h. Overall, 39 ICU patients were eligible and categorized into two groups: extubation success (n = 24) and extubation failure (n = 15) groups. The psoas cross-sectional area was measured at the third lumbar level on computer tomography images. Psoas Muscle Index (PMI) was defined as the psoas cross-sectional area/height2. Primary outcome was to evaluate differences between the psoas cross-sectional area and f(PMI) between the groups, if any. RESULTS: Both groups were comparable in terms of demographic characteristics. Psoas cross-sectional area (extubation success group, 1,776.5 ± 498.2 mm2, extubation failure group, 1,391.2 ± 589.4 mm2; P = 0.022) and PMI (extubation success group, 1,089 ± 270.7 mm2/m2, extubation failure group, 889 ± 338.5 mm2/m2; P = 0.032) were significantly greater in the extubation success group than in the extubation failure group. CONCLUSIONS: The psoas cross-sectional area and PMI can predict extubation outcomes in elderly intensive care patients.