Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

04 November 2019 : Case report  Japan

Pulmonary Barotrauma Following Nasal High-Flow Therapy in a Patient with Bronchiolitis Obliterans Syndrome

Unusual or unexpected effect of treatment

Tsuyoshi Ito1ABCDEF*, Tomoko Suzuki1BCDF, Matsuyoshi Maeda2BCD, Shotaro Iwamoto3CDF, Masahiro Hirayama3CDF, Yasuharu Yamada4CDF, Eiichi Azuma4ABCDEF

DOI: 10.12659/AJCR.918580

Am J Case Rep 2019; 20:1619-1622

Abstract

BACKGROUND: Pulmonary barotrauma is considered as complication of the use of positive-pressure ventilations. Nasal high-flow therapy is increasingly being used as an alternative to them. Nasal high-flow therapy rarely causes pulmonary barotrauma probably because airway pressures are lower when compared with invasive mechanical ventilation. Bronchiolitis obliterans syndrome after allogenic hematopoietic stem cell transplantation is triggered by an alloimmune response in the bronchioles and causes obstruction of the bronchioles. However, the threshold of additional positive pressure has not been determined in a patient with bronchiolitis obliterans syndrome.

CASE REPORT: A 14-year-old female patient with acute myeloid leukemia at high risk of recurrence received an allogeneic hematopoietic stem cell transplantation from an unrelated bone marrow donor. After engraftment, she developed acute graft-versus-host disease, followed by chronic graft-versus-host disease. Ten months post-transplantation, she developed bronchiolitis obliterans syndrome. She continued to receive nasal supplemental oxygen therapy for persistent dyspnea due to bronchiolitis obliterans syndrome. At month +25, hypercapnia was noted. Therefore, we carefully initiated nasal high-flow therapy for dyspnea and adjusted the oxygen dose to maintain 90% SpO2 to avoid life-threatening apnea. The flow rate was as low as 14 to 20 L/min to avoid the risk of barotrauma and the deterioration of air trapping. Unfortunately, she died of respiratory failure at month +31 post-transplantation. A lung autopsy revealed pulmonary barotrauma.

CONCLUSIONS: Nasal high-flow therapy, even at low flow rates, may cause fatal pulmonary barotrauma in bronchiolitis obliterans syndrome.

Keywords: Barotrauma, Bronchiolitis Obliterans, Graft vs Host Disease, noninvasive ventilation, Adolescent, Dyspnea, Fatal Outcome, Hematopoietic Stem Cell Transplantation, Hypercapnia, Leukemia, Myeloid, Acute, Lung Injury, Oxygen Inhalation Therapy, Respiratory Insufficiency

0 Comments

SARS-CoV-2/COVID-19

29 June 2022 : Case report  USA

A Clinical Case of COVID-19 Vaccine-Associated Guillain-Barré Syndrome

Am J Case Rep In Press; DOI: 10.12659/AJCR.936896  

16 June 2022 : Case report  Ecuador

Multidrug-Resistant Klebsiella pneumoniae in a Patient with SARS-Cov-2 Pneumonia in an Intensive Care Unit ...

Am J Case Rep In Press; DOI: 10.12659/AJCR.936498  

13 June 2022 : Case report  Japan

Stenotrophomonas maltophilia Infection Associated with COVID-19: A Case Series and Literature Review

Am J Case Rep In Press; DOI: 10.12659/AJCR.936889  

13 June 2022 : Case report  Saudi Arabia

Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19

Am J Case Rep In Press; DOI: 10.12659/AJCR.936128  

In Press

01 Jul 2022 : Case report  Poland

A 75-Year-Old Female Smoker with Advanced Small-Cell Lung Cancer and Eastern Cooperative Oncology Group Per...

Am J Case Rep In Press; DOI: 10.12659/AJCR.936536  

30 Jun 2022 : Case report  Philippines

Erasmus Syndrome: A Case Report and Literature Review

Am J Case Rep In Press; DOI: 10.12659/AJCR.937061  

30 Jun 2022 : Case report  USA

A Clinical Case of COVID-19 Vaccine-Associated Guillain-Barré Syndrome

Am J Case Rep In Press; DOI: 10.12659/AJCR.936896  

30 Jun 2022 : Case report  China (mainland)

Septic Shock Induced by Acute Pyelonephritis Resulting from Kidney Stones Treated by Double-J Ureteral Sten...

Am J Case Rep In Press; DOI: 10.12659/AJCR.936967  

Most Viewed Current Articles

23 Feb 2022 : Case report  USA

Penile Necrosis Associated with Local Intravenous Injection of Cocaine

DOI :10.12659/AJCR.935250

Am J Case Rep 2022; 23:e935250

17 Feb 2022 : Case report  Oman

Myocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of P...

DOI :10.12659/AJCR.934399

Am J Case Rep 2022; 23:e934399

06 Dec 2021 : Case report  Brazil

Lipedema Can Be Treated Non-Surgically: A Report of 5 Cases

DOI :10.12659/AJCR.934406

Am J Case Rep 2021; 22:e934406

09 Feb 2022 : Case report  Saudi Arabia

Extensive Cerebral Venous Sinus Thrombosis (CVST) After the First Dose of Pfizer-BioNTech BNT162b2 mRNA COV...

DOI :10.12659/AJCR.934744

Am J Case Rep 2022; 23:e934744

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923