PDF(Pubmed)
Abstract：
Lung herniation is a rare complication following cardiopulmonary resuscitation (CPR) and is defined as a protrusion of lung parenchyma through the thoracic wall. This article presents a case in which a patient presented to the hospital with sepsis secondary to community-acquired pneumonia. A 74-year-old female with a background of chronic obstructive pulmonary disease (COPD) suffered a sudden pulseless electrical activity (PEA) cardiac arrest while being managed in the acute medical ward. The CT following the return of spontaneous circulation (ROSC) demonstrated multiple bilateral anterior rib fractures and herniation of the right lung through the right lateral thoracic wall. She was managed in the ICU with ventilatory and cardiovascular support for four days until she suffered a second cardiac arrest, where resuscitation was unsuccessful. In addition to this case report, a literature review was carried out, given the rarity of this pathology. The literature provides only 13 articles on lung herniation due to CPR. The most common injury pattern was anterior rib fractures leading to anterior lung herniation. In our case report, the herniation was away from the fracture site at the lateral chest wall. A common complication was surgical emphysema in several of the articles, as was in our case. The surgical intervention appears to be indicated in large hernias, incarceration, or those causing pain and respiratory compromise. In our case, conservative management was elected, given the patient\'s significant persistent cardiovascular instability unsuitable for interhospital transfer. A high index of suspicion should be adopted for patients who undergo a prolonged period of CPR, including frail patients with underlying health conditions such as chronic lung disease.
摘要：
肺疝是心肺复苏（CPR）后的罕见并发症，被定义为肺实质通过胸壁的突出。本文介绍了一例患者因社区获得性肺炎继发败血症而住院的病例。一名74岁的女性患有慢性阻塞性肺疾病（COPD），在急性病房接受治疗时突然发生无脉性电活动（PEA）心脏骤停。自发循环（ROSC）恢复后的CT显示多发的双侧前肋骨骨折和右肺通过右外侧胸壁突出。她在ICU接受通气和心血管支持治疗四天，直到第二次心脏骤停，复苏不成功的地方。除了这个案例报告，进行了文献综述，考虑到这种病理学的罕见性。文献仅提供了13篇关于CPR引起的肺疝的文章。最常见的损伤类型是前肋骨骨折，导致前肺疝。在我们的案例报告中，疝远离外侧胸壁的骨折部位。常见的并发症是几篇文章中的外科肺气肿，就像我们的案子一样.手术干预似乎适用于大型疝，监禁,或引起疼痛和呼吸损害的人。在我们的案例中,保守的管理层当选，考虑到患者的严重持续性心血管不稳定，不适合院间转院。对于接受长时间CPR的患者，应采取高度怀疑的指标，包括患有慢性肺病等潜在健康状况的虚弱患者。
