Liu Ting, Hong Yu, Peng Yuxuan, Lu Yanan, Cao Lin
Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Transl Cancer Res. 2022 May;11(5):1445-1450. doi: 10.21037/tcr-22-617.
Silent lung is a rare and potentially fatal disease. It is a critical sign of strong bronchospasm or extensive mucus plug blockage, which can result in the obvious weakening of breathing sounds or even disappearance of breathing sounds. Silent lung has an acute onset and rapid progress, which seriously threatens the life of patients. It needs early diagnosis, timely and effective treatment to reverse the persistent severe bronchospasm of patients. If not handled in time, silent lung can cause rapid onset of severe hypoxemia, hypoxic brain injury, and even cardiac arrest. Few studies have been reported on the causes and specific treatments for silent lungs.
We report 2 rare cases of silent lung in this article and summarize the pathogenesis, inducing factors, clinical manifestations of perioperative silent lung. We also review the literature and discuss our solutions and propose other possible solutions for the treatment of silent lung emergencies in clinical settings in order to provide reference for clinical practice of anesthesiologists. Of the patients, 1 displayed a sudden decrease in ventilation volume, an increase in airway resistance, and was changed to pure oxygen. The manual ventilation failed, and there was no fluctuation of the thorax and no respiratory sound during auscultation. Cardiopulmonary resuscitation (CPR) was initiated when cardiac arrest was imminent after hypoxia. The other patient had high airway resistance after anesthesia-induced endotracheal intubation, could not be ventilated, and the carbon dioxide (CO) waveform at the end of breathing disappeared.
Both patients had severe bronchospasm; that is, silent lung. The 2 patients improved after hand-controlled ventilation and the administration of adrenaline and methylprednisolone, and ultimately recovered ventilation.
寂静肺是一种罕见且可能致命的疾病。它是强烈支气管痉挛或广泛黏液栓阻塞的关键体征，可导致呼吸音明显减弱甚至消失。寂静肺起病急、进展快，严重威胁患者生命。需要早期诊断、及时有效的治疗来逆转患者持续的严重支气管痉挛。若不及时处理，寂静肺可导致严重低氧血症迅速发作、缺氧性脑损伤，甚至心脏骤停。关于寂静肺的病因及具体治疗方法的报道较少。
本文报告2例罕见的寂静肺病例，并总结围手术期寂静肺的发病机制、诱发因素、临床表现。我们还回顾了文献，讨论了我们的解决方案，并提出了临床环境中治疗寂静肺急症的其他可能解决方案，以便为麻醉医生的临床实践提供参考。其中1例患者通气量突然下降、气道阻力增加，改为纯氧通气。手控通气失败，听诊时胸廓无起伏且无呼吸音。缺氧后心脏骤停即将发生时开始进行心肺复苏（CPR）。另一例患者麻醉诱导气管插管后气道阻力高，无法通气，呼气末二氧化碳（CO）波形消失。
2例患者均发生了严重支气管痉挛，即寂静肺。2例患者经手控通气及给予肾上腺素和甲泼尼龙后病情改善，最终恢复通气。
