• 15
    Apr
  • Treatment for Collapsed Lung in Critically III Patients: RESULTS

After 12 of the 14 procedures, the chest x-ray film showed complete reexpansion; in the remaining two, case 5 and the secondary procedure in case 12, the x-ray film showed partial re-expansion. In case 5 the collapsed lung reexpanded completely after six days of continuous, intensive, pulmonary care. In case 12, a third bronchoscopic procedure was performed with immediate full re-expansion (Table 1).

Table 1—Clinical Data and Chest X-ray Film Findings on Patients Undergoing Fiberoptic Bronchoscopic Procedures

Case

Age

Sex

Underlying
Condition

Collapse Area

Result

1

24

M

R’t rib fracture
with hemothorax, septic shock, acute renal failure

RLL

CRf

2

52

M

Traumatic
hemopneumothorax

L’t lung

CR

3

56

M

R’t rib fracture
with hemopneumothorax

RLL

CR

4

24

F

Esophageal
stricture for corrosive injury s/p colon interposition

L’t lung

CR

5

18

F*

L’t renal cell
cancer with radical nephrectomy

RUL

PR

6

64

M

R’t lower limb
large skin defect with infection, septic shock

L’t lung

CR

7

48

F

Diabetic mellitus
with uremia post
С
PR, hypoxic encephalopathy

L’t lung

CR

8

29

M

NPC post R/Г,
radiation myelopathy above
C2 level with quadriplegia

LLL

CR

9

28

F*

SLE with
pulmonary infection and respiratory failure

LLL

CR

10

30

M

BAT with internal
bleeding post splenectomy

L’t lung

CR

И

52

F

RHD post AVR
+
MVR
+
tricuspid annuloplasty

RLL

CR

12a

16

M

Traumatic C5, C6
dislocation with quadriplegia

LLL
+
RLL

CR

12b

LUL+RUL

PR

12c

RUL

CR

Case 1 and case 6 died of septic shock 24 and 26 hours after the bronchoscopic procedure. Their arte­rial blood gas value worsened, and they were excluded from the analysis of Pa02 and P(A-a)02 because the worsening was thought to be due to underlying sepsis. A blood gas value was not obtained after case 12 s third procedure. After excluding the above three procedures, the Pa02 of the remaining 11 procedures improved from 79.0 before the procedure to 86.5, 112.1 and 90.6 mm Hg, respectively at 30 minutes, 12, and 24 hours after. The P(A-a)02 declined from 217.5 to 200.3, 150.0 and 152.2 (Fig 2).
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FIGURE 2. The average alveolar-arterial oxygen pressure difference (P[A-a]02) improvement during 24 hours following fiberoptic bron-choscopic procedure.

In case 12, the RUL collapse recurred two days after the first bronchoscopic procedure. He underwent two further procedures with subsequent reexpansion. In case 8, the LLL collapse recurred six days later. A repeat bronchoscopic procedure was recommended but was refused by the patient. This lesion remained at discharge four weeks later.

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