BACKGROUND Massive pulmonary haemorrhage can spoil the entire lung and block the airway in a short period of time due to severe bleeding,which quickly leads to death.Alveolar lavage is an effective method for haemosta...BACKGROUND Massive pulmonary haemorrhage can spoil the entire lung and block the airway in a short period of time due to severe bleeding,which quickly leads to death.Alveolar lavage is an effective method for haemostasis and airway maintenance.However,patients often cannot tolerate alveolar lavage due to severe hypoxia.We used extracorporeal membrane oxygenation(ECMO)to overcome this limitation in a patient with massive pulmonary haemorrhage due to severe trauma and succeeded in saving the life by repeated alveolar lavage.CASE SUMMARY A 22-year-old man sustained multiple injuries in a motor vehicle accident and was transferred to our emergency department.On admission,he had a slight cough and a small amount of bloody sputum;computed tomography revealed multiple fractures and mild pulmonary contusion.At 37 h after admission,he developed severe chest tightness,chest pain,dizziness and haemoptysis.His oxygen saturation was 68%.Emergency endotracheal intubation was performed,and a large amount of bloody sputum was suctioned.After transfer to the intensive care unit,he developed refractory hypoxemia and heparin-free venovenous ECMO was initiated.Fibreoptic bronchoscopy revealed diffuse and profuse blood in all bronchopulmonary segment.Bleeding was observed in the trachea and right bronchus,and repeated alveolar lavage was performed.On day 3,the patient’s haemoptysis ceased,and ECMO support was terminated 10 d later.Tracheostomy was performed on day 15,and the patient was weaned from the ventilator on day 21.CONCLUSION Alveolar lavage combined with ECMO can control bleeding in trauma-induced massive pulmonary haemorrhage,is safe and can be performed bedside.展开更多
Physical traumas are tragic and multifaceted injuries that suddenly threaten life.Although it is the third most common cause of death in all age groups,one out of four trauma patients die due to thoracic injury or its...Physical traumas are tragic and multifaceted injuries that suddenly threaten life.Although it is the third most common cause of death in all age groups,one out of four trauma patients die due to thoracic injury or its complications.Blunt injuries constitute the majority of chest trauma.This indicates the im porta nee of chest trauma among all traumas.Blunt chest trauma is usually caused by motor vehicle accident,falling from height,blunt instrument injury and physical assault.As a result of chest trauma,many injuries may occur,such as pulm onary injuries,and these require urge nt in terve ntion.Chest wall and pulmonary injuries range from rib fractures to flail chest,pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries.Following these injuries,patients may present with a simple dyspnea or even respiratory arrest.For such patie nt,it is imports nt to understa nd the treatme nt logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries.This is because only 10%of thoracic trauma patients require surgical operation and the remaining 90%can be treated with simple methods such as appropriate airway,oxygen support,maneuvers,volume support and tube thoracostomy.Adequate pain control in chest trauma is sometimes the most basic and best treatment.With definite diagnosis,the morbidity and mortality can be significantly reduced by simple treatment methods.展开更多
文摘BACKGROUND Massive pulmonary haemorrhage can spoil the entire lung and block the airway in a short period of time due to severe bleeding,which quickly leads to death.Alveolar lavage is an effective method for haemostasis and airway maintenance.However,patients often cannot tolerate alveolar lavage due to severe hypoxia.We used extracorporeal membrane oxygenation(ECMO)to overcome this limitation in a patient with massive pulmonary haemorrhage due to severe trauma and succeeded in saving the life by repeated alveolar lavage.CASE SUMMARY A 22-year-old man sustained multiple injuries in a motor vehicle accident and was transferred to our emergency department.On admission,he had a slight cough and a small amount of bloody sputum;computed tomography revealed multiple fractures and mild pulmonary contusion.At 37 h after admission,he developed severe chest tightness,chest pain,dizziness and haemoptysis.His oxygen saturation was 68%.Emergency endotracheal intubation was performed,and a large amount of bloody sputum was suctioned.After transfer to the intensive care unit,he developed refractory hypoxemia and heparin-free venovenous ECMO was initiated.Fibreoptic bronchoscopy revealed diffuse and profuse blood in all bronchopulmonary segment.Bleeding was observed in the trachea and right bronchus,and repeated alveolar lavage was performed.On day 3,the patient’s haemoptysis ceased,and ECMO support was terminated 10 d later.Tracheostomy was performed on day 15,and the patient was weaned from the ventilator on day 21.CONCLUSION Alveolar lavage combined with ECMO can control bleeding in trauma-induced massive pulmonary haemorrhage,is safe and can be performed bedside.
文摘Physical traumas are tragic and multifaceted injuries that suddenly threaten life.Although it is the third most common cause of death in all age groups,one out of four trauma patients die due to thoracic injury or its complications.Blunt injuries constitute the majority of chest trauma.This indicates the im porta nee of chest trauma among all traumas.Blunt chest trauma is usually caused by motor vehicle accident,falling from height,blunt instrument injury and physical assault.As a result of chest trauma,many injuries may occur,such as pulm onary injuries,and these require urge nt in terve ntion.Chest wall and pulmonary injuries range from rib fractures to flail chest,pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries.Following these injuries,patients may present with a simple dyspnea or even respiratory arrest.For such patie nt,it is imports nt to understa nd the treatme nt logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries.This is because only 10%of thoracic trauma patients require surgical operation and the remaining 90%can be treated with simple methods such as appropriate airway,oxygen support,maneuvers,volume support and tube thoracostomy.Adequate pain control in chest trauma is sometimes the most basic and best treatment.With definite diagnosis,the morbidity and mortality can be significantly reduced by simple treatment methods.
