Mayahara Taku, Katayama Tomohiro, Higashi Yuki, Asano Jun, Sugimoto Takashi
Emergency Medicine, Kōbe Ekisaikai Hospital, Kobe, JPN.
Emergency Medicine, Kobe University Graduate School of Medicine, Kobe, JPN.
Cureus. 2023 Dec 20;15(12):e50820. doi: 10.7759/cureus.50820. eCollection 2023 Dec.
A 54-year-old male with severe hypoxia was transferred to our hospital after choking on a mochi. Chest computed tomography revealed negative pressure pulmonary edema without pneumothorax. Endotracheal intubation was performed, and pressure-controlled ventilation was initiated. Following admission to the intensive care unit, his respiratory condition was stable in both the supine and left decubitus positions. However, every time he was placed in the right decubitus position, the tidal volume decreased by half, and SpO₂ dropped rapidly to 80%, which recovered soon after returning to the supine position. Chest radiography was performed the following day, revealing grade II right pneumothorax, and a chest tube placement stabilized his respiratory status in the right decubitus position. Air leakage ceased within a few hours. Extubation was successful on the fifth hospital day, and the chest tube was removed on the eighth hospital day. To our knowledge, there are no previous reports on position-dependent symptoms of pneumothorax during mechanical ventilation. Clinicians should consider the possibility of pneumothorax on that same side when respiratory deterioration is observed only in one lateral decubitus position during mechanical ventilation.
一名54岁男性因食用糯米团窒息后被转送至我院。胸部计算机断层扫描显示为负压性肺水肿，无气胸。进行了气管插管，并开始进行压力控制通气。入住重症监护病房后，他在仰卧位和左侧卧位时呼吸状况均稳定。然而，每次将他置于右侧卧位时，潮气量减半，血氧饱和度（SpO₂）迅速降至80%，回到仰卧位后很快恢复。次日进行胸部X线检查，显示为Ⅱ级右侧气胸，放置胸腔引流管后他在右侧卧位时呼吸状况稳定。数小时内漏气停止。住院第5天成功拔管，住院第8天拔除胸腔引流管。据我们所知，此前尚无关于机械通气期间气胸的体位相关症状的报道。临床医生在机械通气期间仅在一个侧卧位观察到呼吸恶化时，应考虑同侧气胸的可能性。
