Unilateral Bronchospasm during Pleurodesis in an Asthmatic Patient

Narr, Bradly J.; Fromme, Glenn A.; Peters, Steve G.

doi:10.1378/chest.98.3.767

Cited by 7 publications

(3 citation statements)

References 12 publications

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“…ILV has been used in a broad range of asymmetric lung diseases. Asymmetric parenchymal lung diseases [ 4 , 27 , 34 ], postoperative management of single lung transplant complications [ 1 ], bronchopleural fistulas [ 53 , 55 ] and unilateral bronchospasm following pleurodesis [ 56 ] are examples. Its role in acute bilateral lung injury remains unproven.…”

Section: Physiological Lung Separationmentioning

confidence: 99%

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2005

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Independent lung ventilation (ILV) can be classified into anatomical and physiological lung separation. It requires either endobronchial blockade or double-lumen endotracheal tube intubation. Endobronchial blockade or selective double-lumen tube ventilation may necessitate temporary one lung ventilation. Anatomical lung separation isolates a diseased lung from contaminating the nondiseased lung. Physiological lung separation ventilates each lung as an independent unit. There are some clear indications for ILV as a primary intervention and as a rescue ventilator strategy in both anatomical and physiological lung separation. Potential pitfalls are related to establishing and maintaining lung isolation. Nevertheless, ILV can be used in the intensive care setting safely with a good understanding of its limitations and potential complications. IntroductionIndications for independent lung ventilation (ILV) in critical care medicine are poorly defined compared to their use in thoracic anaesthesia. Although first described in anaesthetic practice in 1931, it was only in 1976 that ILV was reported in an intensive care setting [1,2]. Specific primary indications such as whole lung lavage [3] and massive hemoptysis [4] have since been identified. There is also emerging data on ILV as a rescue ventilator strategy when conventional ventilator techniques fail [5].Intubation alternatives for ILV include endobronchial blockers or double-lumen endotracheal tubes. Endobronchial blockers or selective double-lumen tube ventilation may limit respiratory support to one lung ventilation (OLV) temporarily. There are some ventilatory strategies adopted from thoracic anaesthesia that can be used to improve oxygenation in OLV. ILV can have several other variations including synchronous and asynchronous ventilation.ILV can be classified as being used for either anatomical or physiological separation of the lungs [4]. Anatomical separation aims to isolate one lung from potentially injurious contaminants from the other diseased lung. Indications for anatomical lung separation include the management of massive hemoptysis and interbronchial aspiration of copious secretions [4], as well as whole lung lavage for pulmonary alveolar proteinosis [3] (Table 1). Anatomical isolation remains a short-term intervention and is not used for prolonged ventilation because infections cannot be reliably localised by blockers and hemoptysis can only be transiently tamponaded. It allows temporary ventilatory support while definitive treatment like surgery or embolisation is instituted.In physiological lung separation, each lung is ventilated as an independent unit after isolating one side from the other. Different ventilator strategies can be used on each side because of asymmetric lung disease resulting in different airway resistance and lung compliance. Unilateral parenchymal lung diseases [4], post-operative complications of single lung transplants [1] and bronchopleural fistulas [6] are common indications for physiological separation (Table 1). ILV ...

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Section: Physiological Lung Separationmentioning

confidence: 99%

“…When ILV is employed in unilateral obstructive airway diseases, the affected side is ventilated with a low respiratory rate, low tidal volume and prolonged expiratory time to prevent the accumulation of intrinsic PEEP while the unaffected side is supported with conventional ventilator settings [ 56 ].…”

Section: Physiological Lung Separationmentioning

confidence: 99%

Untitled

2005

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“…Unilateral bronchospasm usually occurs due to topical irritation of the respiratory system [12,13]. However, unilateral bronchospasm in our case was triggered by the systemic effects of intravenous agents.…”

Section: Discussionmentioning

confidence: 63%

Recurrent unilateral lung ventilation disorder in a patient that experienced rocuronium-induced anaphylactic bronchospasm during laparoscopic rectal surgery -A case report-

Choi

Mok

et al. 2010

Korean J Anesthesiol

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Rocuronium is the anesthetic agent most likely to cause anaphylaxis. Immediately after intravenous rocuronium administration, the authors experienced ventilatory impairment due to unilateral bronchospasm (left lung), which was relieved by emergency treatment. However, 80 minutes after beginning laparoscopic surgery for rectal cancer, the left lung suddenly re-collapsed under pneumoperitoneum in the Trendelenburg position. A postoperative intradermal test revealed that rocuronium, vecuronium, atracurium, succinylcholine, or thiopental could induce anaphylaxis in this patient, but it was not established whether the second incident during surgery was due to endobronchial intubation or anaphylactic bronchospasm. This case cautions that under pneumoperitoneum in the Trendelenburg position, patients suspected of being prone to anaphylactic bronchospasm should also be considered at risk of endobronchial intubation.

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