Unilateral postobstructive pulmonary edema following double-lumen endobronchial tube intubation

SummaryHerein, we report a male patient underwent a video-assisted thoracoscopic resection of left lower lobe intralobar bronchopulmonary sequestration that developed unilateral postobstructive pulmonary edema following double-lumen endobronchial tube intubation. Pulmonary edema subsided after receiving positive pressure ventilation at positive end-expiratory pressure of 5cm H2O and the patient was extubated 24h later. To prevent this complication, correct placement of the tube should be assessed by auscultation during intermittent ventilation of each lung and fiberoptic bronchoscope should always be performed through both tracheal and bronchial lumens after intubation

Diaphragmatic parameters by ultrasonography for predicting weaning outcomes

Abstract Background Diaphragmatic dysfunction remains the main cause of weaning difficulty or failure. Ultrasonographic measurement of diaphragmatic function can be used to predict the outcomes of weaning from mechanical ventilation. Our primary objective was to investigate the performance of various sonographic parameters of diaphragmatic function for predicting the success of weaning from mechanical ventilation. Methods We prospectively enrolled 68 adult patients requiring mechanical ventilation who were admitted to the intensive care unit from June 2013 to November 2013. The diaphragmatic inspiratory excursion, time to peak inspiratory amplitude of the diaphragm (TPIAdia), diaphragmatic thickness (DT), DT difference (DTD), and diaphragm thickening fraction (TFdi) were determined by bedside ultrasonography performed at the end of a spontaneous breathing trial. A receiver operating characteristic curve was used for analysis. Results In total, 62 patients were analyzed. The mean TPIAdia was significantly higher in the weaning success group (right, 1.27 ± 0.38 s; left, 1.14 ± 0.37 s) than in the weaning failure group (right, 0.97 ± 0.43 s; left, 0.85 ± 0.39 s) (P  0.8 s in predicting weaning success were 92, 46, 89, and 56%, respectively. The diaphragmatic inspiratory excursion, DTD, and TFdi were associated with reintubation within 48 h. The P values were 0.047, 0.021, and 0.028, and the areas under the receiver operating characteristic curve were 0.716, 0.805, and 0.784, respectively. Conclusion Among diaphragmatic parameters, TPIAdia exhibits good performance in predicting the success of weaning from mechanical ventilation. This study demonstrated a trend toward successful use of TPIAdia rather than diaphragmatic inspiratory excursion as a predictor of weaning from mechanical ventilation