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Pneumomediastinum while using mechanical insufflation-exsufflation after recovery from riluzole-induced interstitial lung disease
- Source :
- eNeurologicalSci, eNeurologicalSci, Vol 22, Iss, Pp 100326-(2021)
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- We, herein, report a 61-year-old male patient with amyotrophic lateral sclerosis (ALS) complicated pneumomediastinum while using mechanical insufflation-exsufflation (MI-E) after recovery from riluzole (RZ)-induced interstitial lung disease (RZ-ILD). After the treatment of RZ-ILD, he required non-invasive mechanical ventilation (NIV) at minimal pressure settings and MI-E to manage ALS-related breathing and airway-clearance issues, respectively. After a while, he developed progressive worsening dyspnoea, and chest computed tomography revealed extensive pneumomediastinum that had spread to the area surrounding the oesophagus, the retrosternal space, and the pericardial space. He was treated with immediate discontinuation of MI-E; however, he had to keep using NIV to support his severe respiratory muscle involvement. Pneumomediastinum gradually reduced in size and no recurrence of pneumomediastinum occurred. The clinical course of our patient suggests that excessive coughing associated with MI-E combined with his previous RZ-ILD, which potentially renders his lungs vulnerable to airway pressure, may have been the aetiological factors for secondary pneumomediastinum, i.e. barotrauma. Clinicians should be aware of the risk of pneumomediastinum while using MI-E in patients with ALS, who have other pre-existing risk factors for pneumomediastinum, such as drug-induced ILD in our case.<br />Highlights • Pneumomediastinum could occur while using MI-E in ALS patients who recovered from drug-induced interstitial lung disease. • MI-E could be a cause of secondary pneumomediastinum in patients with pre-existing risk factors for pneumomediastinum. • Pneumomediastinum should be considered when acute progressive dyspnoea develops during the use of MI-E in ALS patient.
- Subjects :
- Insufflation
RZ, riluzole
medicine.medical_treatment
Pneumomediastinum
Case Report
Interstitial lung disease
GGO, ground-glass opacities
lcsh:RC346-429
03 medical and health sciences
0302 clinical medicine
Respiratory muscle
Mechanical insufflation-exsufflation
Medicine
030212 general & internal medicine
MI-E, mechanical insufflation-exsufflation
lcsh:Neurology. Diseases of the nervous system
RZ-ILD, riluzole-induced interstitial lung disease
Mechanical ventilation
Riluzole
NIV, non-invasive mechanical ventilation
business.industry
respiratory system
Amyotrophic lateral sclerosis
ALS, amyotrophic lateral sclerosis
medicine.disease
CT, computed tomography
KL-6, Krebs von den Lungen-6
respiratory tract diseases
Barotrauma
COPD, chronic obstructive pulmonary disease
Neurology
Anesthesia
Breathing
ILD, interstitial lung disease
Exsufflation
Airway
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 24056502
- Volume :
- 22
- Database :
- OpenAIRE
- Journal :
- eNeurologicalSci
- Accession number :
- edsair.doi.dedup.....9266300625c99ba5770314965b8a61d7