CME INDIA Case Presentation by Dr. Atri Gangopadhyay, Pulmonologist, Pulse Hospital, Ranchi.

CME INDIA Case Study

How Presented?

  • Patient was managed for CKD SEPSIS LRTI at another hospital including intubation, vasopressors and successful extubation.
  • However, Patient was not getting weaned from Non-invasive ventilator, and 5 days after extubation, condition again worsened.

What CXR revealed?

  • A chest Xray revealed complete left lung Collapse.

Why was she referred?

  • Patient was referred for bronchoscopy.
Left Lung Collapse in CKD 80-Year-Old Lady

What was the challenge?

  • 80-year-old lady, needing 6 litres oxygen to maintain Saturation 90%, thus risk of desaturation and reintubation during procedure.

What was done?

  • Procedure was uneventful with awake bronchoscopy via left trans nasal route that showed mucus plug in left main bronchus covering the CARINA. Plug removed with restoration of endobronchial patency. Post procedure, Patient showing saturation 95% at 2 litre oxygen.
Left Lung Collapse in CKD 80-Year-Old Lady

Left Lung Collapse in CKD 80-Year-Old Lady

Take-Home Points

  • Anticipate lung Collapse in elderly bedridden patient who is recovering from:
    • Chest infection
    • Fluid overload
    • Extubated
  • Early and aggressive mobilization compounded with good mouth/ oral hygiene will prevent this calamity.
  • Suspect lung collapse whenever unexplained deterioration in such patients.

CME INDIA Discussion

Dr. S. K. Goenka, Begusarai:

  • Is the left lung collapsed due to obstructions in the lt main bronchus?

Dr. Atri Gangopadhyay, Pulmonogist, Ranchi:

  • Yes, there was mucus plug in left main bronchus reaching till carina.

Dr. Raju Sharma, Sr. Physician, Jamashedapur:

  • Amazing teaching. We often forget the obvious.

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