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The use of cryotherapy via bronchoscopy for removal of obstructing tracheobronchial thrombi.

Cook MI, Papadimos TJ - Int J Crit Illn Inj Sci (2015 Jul-Sep)

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Division of Critical Care Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.

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Dear Editor, Cryotherapy can be used for endoscopic management of tracheobronchial obstruction... However, after decannulation she developed adult respiratory distress syndrome and was unable to maintain adequate oxygenation despite efforts with oscillatory ventilation... As a result, venovenous (VV) ECMO was initiated... She subsequently developed diffuse alveolar hemorrhage that manifested as large blood clots throughout the tracheobronchial tree completely obstructing the airway, necessitating nearly daily bronchoscopy without resolution [Figure 1]... Cryotherapy was employed to attempt to remove the clot burden and ameliorate her respiratory failure... Extensive clots were removed, but some still remained in the RUL and LLL [Figure 2]... Overall, the post procedure lumen size was substantially improved as compared to before the procedure... In this case, cryotherapy had the advantage of aiding the removal of the extensive clot burden in the tracheobronchial tree without further damage to the already friable mucosa... Freezing of the target is dependent upon water content and as such, cartilage and fibrous tissues are spared, reducing the risk of airway perforation... Moreover, cryotherapy has hemostatic effects and so the risk of bleeding is also reduced... Its safety profile and effectiveness make it an excellent choice for removal of clot burden in the setting of diffuse alveolar hemorrhage.

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Related in: MedlinePlus

Obstructing blood clot in left lower lobe
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Figure 1: Obstructing blood clot in left lower lobe

Mentions: A 45-year-old female who presented for aortic dissection repair via left thoracotomy. She was unable to be weaned off of bypass secondary to pulmonary contusions and concern for pulmonary hemorrhage; venoarterial (VA) extracorporeal membrane oxygenation (ECMO) was placed intraoperatively. She remained on VA ECMO for 4 days postoperatively. However, after decannulation she developed adult respiratory distress syndrome and was unable to maintain adequate oxygenation despite efforts with oscillatory ventilation. As a result, venovenous (VV) ECMO was initiated. She subsequently developed diffuse alveolar hemorrhage that manifested as large blood clots throughout the tracheobronchial tree completely obstructing the airway, necessitating nearly daily bronchoscopy without resolution [Figure 1]. Furthermore, the clot could not be removed either with suction or biopsy forceps. Cryotherapy was employed to attempt to remove the clot burden and ameliorate her respiratory failure. Cryotherapy was performed in the trachea, left mainstem bronchus, right mainstem bronchus, the right upper lobe (RUL), left upper lobe (LUL), and in the left lower lobe (LLL) of the lung. There were 10 cryoprobe applications to the airway and each application was for 20 s. Extensive clots were removed, but some still remained in the RUL and LLL [Figure 2]. Overall, the post procedure lumen size was substantially improved as compared to before the procedure.


The use of cryotherapy via bronchoscopy for removal of obstructing tracheobronchial thrombi.

Cook MI, Papadimos TJ - Int J Crit Illn Inj Sci (2015 Jul-Sep)

Obstructing blood clot in left lower lobe
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4613422&req=5

Figure 1: Obstructing blood clot in left lower lobe
Mentions: A 45-year-old female who presented for aortic dissection repair via left thoracotomy. She was unable to be weaned off of bypass secondary to pulmonary contusions and concern for pulmonary hemorrhage; venoarterial (VA) extracorporeal membrane oxygenation (ECMO) was placed intraoperatively. She remained on VA ECMO for 4 days postoperatively. However, after decannulation she developed adult respiratory distress syndrome and was unable to maintain adequate oxygenation despite efforts with oscillatory ventilation. As a result, venovenous (VV) ECMO was initiated. She subsequently developed diffuse alveolar hemorrhage that manifested as large blood clots throughout the tracheobronchial tree completely obstructing the airway, necessitating nearly daily bronchoscopy without resolution [Figure 1]. Furthermore, the clot could not be removed either with suction or biopsy forceps. Cryotherapy was employed to attempt to remove the clot burden and ameliorate her respiratory failure. Cryotherapy was performed in the trachea, left mainstem bronchus, right mainstem bronchus, the right upper lobe (RUL), left upper lobe (LUL), and in the left lower lobe (LLL) of the lung. There were 10 cryoprobe applications to the airway and each application was for 20 s. Extensive clots were removed, but some still remained in the RUL and LLL [Figure 2]. Overall, the post procedure lumen size was substantially improved as compared to before the procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Division of Critical Care Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Dear Editor, Cryotherapy can be used for endoscopic management of tracheobronchial obstruction... However, after decannulation she developed adult respiratory distress syndrome and was unable to maintain adequate oxygenation despite efforts with oscillatory ventilation... As a result, venovenous (VV) ECMO was initiated... She subsequently developed diffuse alveolar hemorrhage that manifested as large blood clots throughout the tracheobronchial tree completely obstructing the airway, necessitating nearly daily bronchoscopy without resolution [Figure 1]... Cryotherapy was employed to attempt to remove the clot burden and ameliorate her respiratory failure... Extensive clots were removed, but some still remained in the RUL and LLL [Figure 2]... Overall, the post procedure lumen size was substantially improved as compared to before the procedure... In this case, cryotherapy had the advantage of aiding the removal of the extensive clot burden in the tracheobronchial tree without further damage to the already friable mucosa... Freezing of the target is dependent upon water content and as such, cartilage and fibrous tissues are spared, reducing the risk of airway perforation... Moreover, cryotherapy has hemostatic effects and so the risk of bleeding is also reduced... Its safety profile and effectiveness make it an excellent choice for removal of clot burden in the setting of diffuse alveolar hemorrhage.

No MeSH data available.


Related in: MedlinePlus