Conclusions: Prone position recruited the edematous lung further than recruitment maneuvers and reversed overinflation, resulting in a more homogeneous distribution of aeration. The effects of the prone position were more pronounced in patients with lobar ALI.
Objectives: To report the ultrasound (US) features in prenatal cases of suspected congenital pulmonary airway malformation or unspecified lung lesions with a final surgical pathologic diagnosis of congenital lobar overinflation (CLO).
overinflation
Conclusions: Congenital lobar overinflation should be considered in cases of prenatal echogenic lung lesions without macrocysts or classic findings of bronchial atresia. Hypervascularity may be an important imaging feature of a subset of CLO. Most cases become less conspicuous, decrease in size without overt hydrops, and are asymptomatic postnatally.
Congenital lobar overinflation (CLO), previously called congenital lobar emphysema, is a congenital lung abnormality that results in progressive overinflation of one or more lobes of a neonate's lung.
In congenital lobar overinflation, a lobe (or more) becomes distended and may or may not have an overabundance of alveoli. There are many presumed mechanisms for progressive overdistension of a lobe, including obstruction, cartilage deficiency, dysplasia, and immaturity 2. Most cases are idiopathic.
In this case report and literature review, we discuss that overinflation of ETT cuffs may result in cuff pressures that may obstruct the tube and if ventilation is not reestablished quickly, hemodynamic instability and hypoxia may ensue. Herein a case of ETT overinflation resulting in hemodynamic and ventilatory compromise is presented. A 68-year-old woman undergoing microlaryngoscopy developed hypoxic cardiac arrest after cuff reinflation intraoperatively. Advanced cardiac life support (ACLS) was initiated and replacement of the ETT resulted in the return of ventilation and spontaneous circulation. It is reasonable to conclude that airway compromise occurred due to manual cuff overinflation. To the best of our knowledge, this is one of the few case reports demonstrating airway obstruction secondary to ETT cuff overinflation occurring intraoperatively in an ASC setting.
Regular monitoring of intracuff pressures and routine deflation and reinflation of the cuff to the no-leak point may prevent cuff overinflation. However, identifying an optimal method of doing so is challenging and poorly studied. Methods such as manual palpation, which is commonly recommended, is an unreliable methods for estimating cuff pressure [12]. There are several commercially available cuff inflator measuring devices available to assist in this problem [13]. A recent randomized control trial found that automated vs. manual correction of cuff pressure was associated with a significantly lower rate of underinflation (2% vs. 15%, P
Anesthesiologists should also be aware of common risk factors for cuff overinflation, namely the use of N2O, tube positioning, and length of the procedure. Combes et al. conducted a study of 50 patients where the ETT cuff was inflated with either saline or air. The authors found that excess cuff pressure during balanced anesthesia with isoflurane and nitrous oxide resulted in a greater incidence of a sore throat for the air treatment group in the postanesthesia care unit (76% vs 20%) and 24 hours after extubation (42 vs. 12%, P
Congenital lobar overinflation is characterized by disruption of bronchopulmonary development which produces lobar or segmental bronchial abnormalities and overinflation of normal lung tissue. This is a 44-year old man, never smoker, who presents dyspnea every time he arrived in highlands, marked decreased breathing sounds and hyperresonance in the left hemithorax. Imaging studies suggested left upper lobe overinflation. The affected area was resected resulting in symptoms improvement. Accepted treatment is resection, however conservative management has been proposed for asymptomatic patients because cases of spontaneous improvement have been described. We recommend close monitoring and resection if symptoms or overinflation progress.
Congenital lobar overinflation (CLOI) is one of the most important causes of infantile respiratory distress (RD). We aim to evaluate our experience in CLOI management emphasizing on clinical features, diagnostic modalities, surgery and outcomes.
For the first time in an experimental study, computed tomographic sections of the whole lung were obtained at end-expiration and end-inspiration at different intrathoracic pressures. Scanning the whole lung is essential for an accurate determination of lung volumes of gas and tissue, lung aeration, and alveolar recruitment. 2In a majority of patients with acute respiratory distress syndrome (ARDS) when lying supine, lung re-aration resulting from positive end-expiratory pressure (PEEP) decreases from the apex to the diaphragm. 3In contrast, lung overinflation predominates in caudal and nondependent lung regions. 4As a consequence, assessing changes in lung aeration resulting from PEEP on a single computed tomographic section presents the risk of grossly mis-estimating alveolar recruitment and lung overinflation. In their study, Lim et al. used a multi-detector Light Speed Scanner, which allowed scanning of the whole lung with an accurate spatial resolution (voxel size ranging between 1.2 and 1.74 mm3) during a breath-holding lasting less than 10 s.
With regard to the clinical application of recruitment maneuvers and, more generally, to the different techniques of alveolar recruitment, it seems essential to consider the risk of overdistension and to avoid focusing exclusively on the potential for recruitment. 30Optimizing alveolar recruitment can be defined as providing the greatest lung re-aeration without inducing significant lung overinflation. Because a recruitment maneuver is not likely to increase lung overinflation, as demonstrated by Lim et al. , it could be an attractive adjunct to PEEP for optimizing the re-aration of a collapse-prone lung.
Lobar emphysema or - more correctly - lobar overinflation as it is recently described, is a rare condition more common in male neonates. The left upper lobe is most commonly affected. It is one entity out of a spectrum of congenital lung malformations, and it may be associated with other malformations [1, 6]. When there is any double about imaging findings it is prudent to confirm them with CT, as in this case, instead of proceeding to chest drain insertion [2]. It is uncommon to find a long term follow-up of such cases into adulthood [2]. The management of symptomatic cases is usually surgical and not controversial. The management of asymptomatic cases or incidental findings of an unrelated cause is conservative (observation) or surgical. We live in a world of patient choice so it is fair to state that modern management is guided by patient choice; in our case the patient had opted for conservative management of infections as and when they occurred, and the condition has not affected her life adversely to warrant surgical intervention. The role of imaging is to support patients opting for conservative management when there are no underlying structural abnormalities like cysts or bullae, or to support the surgical team when they are present [2,3]. Imaging also plays a valuable role in the preoperative assessment of this condition [4]. It is also important to make patients aware of the diagnosis, and to document it in medical notes if and when they need anaesthetic intervention [5]. Written patient consent for this case was waived by the Editorial Board. Patient data may have been modified to ensure patient anonymity. 2ff7e9595c
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