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Challenges and Opportunities in Emphysema

Challenges and Opportunities in Emphysema

Adekanye, A. G., Umana, A. N., Akintomide, A. O., Nakanda, B., Mgbe, R. B., Offiong, M. E., & Asuquo, B. 2017,


Subcutaneous emphysema after adeno-tonsillectomy is rarely encountered. One of such cases following adenotonsilectomy was seen in our institution.

We report the case of a 5-year-old girl who developed cervicofacial emphysema and pneumomediastinum following retching and vomiting 6 hours after a routine adenotonsillectomy. Radiograph of the jaws and chest revealed subcutaneous emphysema. Previously published cases showed that the cause was most likely due to air passing into subcutaneous tissue through the tonsillar fossa and superior constrictor muscle into the facial layers of the neck following a bout of coughing and straining (crying), or the use of positive pressure ventilation. The emphysema can then spread to parapharyngeal and retropharyngeal spaces with associated morbidities. Further complications may include pneumothorax and pneumomediastinum and this should be excluded.

Martínez‐Hernández, L., Jung, C. Y., Gerardo, M., Manuel, L., Claudia, L., & José, D. (2022)


To date, few report cases of spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema without any cause of trauma have been observed in patients with COVID-19 pneumonia. We present a case of a 66-year-old male patient who developed such complication on day 19 of hospitalization, without requiring non-invasive or invasive ventilator. CT thorax scan revealed widespread bilateral ground glass opacities with pneumothorax, pneumomediastinum, and subcutaneous emphysema, which were resolved totally on the following 29 days. We highlight preexisting mechanisms for pulmonary air-leak syndrome and importance of prompt recognition to establish adequate therapy in patients with COVID-19 pneumonia.

Salinas, M., & Florenzano, M. (2021)


Interstitial lung diseases (ILD) are a complex and diverse group of disorders. ILD are more frequently diagnosed and prevalent now. In this article, diagnosis approach, including new bronchoscopy and genetic tools, and some recently added concepts are revisited, as progressive fibrosing interstitial lung diseases and interstitial lung abnormalities.

Recently information relative to idiopathic pulmonary fibrosis is shown, including genetics and pathophysiology. We look over the dynamic world of interstitial lung diseases related to connective tissue diseases, principal characteristics of this group and the principles that define which of the various available therapies should be chosen. Finally new concepts and guidelines published about the diagnosis and management of hypersensitivity pneumonitis are reported. New data and treatments have changed our traditional vision of these lung diseases and we will new options in the next years.

Zhang, W., & Mehta, A. (2018, August 16)


Background: Pursed lip breathing (PLB) is an important aspect of respiratory exercise training utilized by patients with chronic obstructive pulmonary disease (COPD) to alleviate symptoms of dyspnea. This modality became a part of the recommended treatment during pulmonary rehabilitation and was endorsed by ACCP/AACVPR (American College of Chest Physicians/ American Association of Cardiovascular and Pulmonary Rehabilitation) in 1997. 1 Theoretically, PLB promotes maximum exhalation by creating back-pressure inside the airways and thereby improving patency. These changes in respiratory mechanics counteract the pathophysiology leading to emphysema and optimize pulmonary function, thus decreasing dyspnea symptoms associated with dynamic hyperinflation. While there is no overwhelming evidence to support the efficacy of PLB, clinicians still encourage their patients to use PLB techniques during their pulmonary rehabilitation program.

Methods: A total of 26 research articles met criteria for inclusion in this review.

The purpose of this review is to better understand the historical perspectives and evidence surrounding the use of PLB.

Discussion: Most evidence suggested that PLB could be an effective self-care management that optimizes pulmonary function. The knowledge gained from this review may be used to explore implementation strategies utilizing pursed lip breathing exercises for developing a home-based pulmonary rehabilitation program in order to optimize pulmonary function and quality of life in COPD patients.

Palma, D., Cracchiolo, A., Librizzi, D., La Sala, A., & Agrusa, L. (2021)


Introduction: The aim of our retrospective analysis is to evaluate the results of conservative management of acquired tracheoesophageal fistulae (TEF). TEF are rare but potentially life-threatening emergencies which can be of either spontaneous or iatrogenic origin. Spontaneous ones can be congenital or secondary to malignancy. For acquired ones numerous causes have been documented, the most common of which are endotracheal and tracheostomy tube-related injuries.

Methods: From February 2016 to March 2019 seven patients (5 men; 2 women) with acquired TEF were diagnosed in our intensive care unit (ICU). The injury occurred after dilational percutaneous tracheostomy in three patients, after esophageal endoscopy in one patient, after cuff-related ruptures in three intubated and mechanically ventilated patients. Our patients had no particular medical history. Mean age: 46 years. Mean duration of signs before diagnosis: 8 hours. The median length of the injury was 1,4 cm. The mean duration of hospitalization in the ICU was 31 days.

Results: All patients underwent conservative management: antibiotic therapy, close brochoscopic controls, percutaneous endoscopic gastrostomy and tomographic investigation. No mediastinitis was observed. Two patients died from causes unrelated to the tracheal injury.

Conclusions: Successful management of acquired TEF requires a fast and straightforward diagnostic evaluation. According to our experience, conservative management of TEF may be a save option in patients with uncomplicated ventilation and moderate and nonprogressive emphysema.

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