Case report: A ball valve blood clot in the airways – life-saving whole tube suction

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Respiratory tract obstruction due to a blood clot may result in life threatening ventilatory impairment. Ball valve blood clot obstructions of the airways are rare. A ball valve blood clot acts as a one-way valve, allowing (near) normal air entry into the airways, but (completely) blocking expiration. In a near fatal case of obstruction of the airways by a ball valve blood clot, we performed 'whole tube suction' to resolve the airway problem.

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Publié le 01 janvier 2004
Nombre de lectures 9
Langue English
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Available onlinehttp://ccforum.com/content/8/5/R289
August 2004Vol 8 No 5 Open Access Research Case report: A ball valve blood clot in the airways – lifesaving whole tube suction 1 23 Dave A Dongelmans, Rene E Jonkersand Marcus J Schultz
1 AnaesthesiologistIntensivist, Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands 2 Pulmonologist, Department of Pulmonology, Academic Medical Center, Amsterdam, The Netherlands 3 InternistIntensivist, Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands
Corresponding author: Marcus J Schultz, m.j.schultz@amc.uva.nl
Received: 01 June 2004
Accepted: 09 June 2004
Published: 28 June 2004
Critical Care2004,8:R289R290 (DOI 10.1186/cc2903) This article is online at: http://ccforum.com/content/8/5/R289
© 2004 Dongelmanset al.; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
Abstract Respiratory tract obstruction due to a blood clot may result in life threatening ventilatory impairment. Ball valve blood clot obstructions of the airways are rare. A ball valve blood clot acts as a oneway valve, allowing (near) normal air entry into the airways, but (completely) blocking expiration. In a near fatal case of obstruction of the airways by a ball valve blood clot, we performed 'whole tube suction' to resolve the airway problem.
Keywords:blood clot, airway obstruction, suction, tracheostomy
chest. Several days later the oxygenhemoglobin saturation Introduction Respiratory tract obstruction due to a blood clot followingsuddenly dropped to 80%. The minute ventilation dropped to haemorrhage may result in lifethreatening ventilatory impairinadequately low levels and the pressure–volume curve exhib ment. We report a near fatal case of obstruction of the airwaysited signs of severe airway obstruction. Oxygenation during by a ball valve blood clot, in which we performed 'whole tubemanual ventilation was adequate, but after reconnection to the suction' to resolve the airway problem.mechanical ventilator it dropped to 80%. Repeated airways suction was unsuccessful. Fibreoptic bronchoscopy through the tracheostomy tube revealed a large blood clot intermit Case report A 53yearold female with (longstanding) chronic renal insuftently obstructing the distal end of the tube. The clot pre ficiency was admitted to our intensive care unit because ofsented a subtotal occlusion of the tube, acting as a ball valve several complications that occurred following her receipt of aobstructing the tube during expiration. Again we attempted to kidney transplant 2 weeks before. During the postoperativeremove the clot by suctioning the airways, either using the course the patient developed a severe peripheral neuropathy,catheter or by bronchoscopy, but without success. Because which resulted in severe muscle weakness. It was presumedthe condition of the patient consistently deteriorated whenever that weaning from the ventilator would be difficult, and a trashe was reconnected to the mechanical ventilator, the deci cheotomy was therefore performed.sion was taken to remove the tracheostomy tube in the hope that the clot would also be removed, but this unfortunately did After an uneventful tracheotomy, the patient was ventilated fornot occur. the next few days with normal pressures and adequate oxy genation. No problems were encountered when suctioning theAn oropharyngeal tube was placed in order to continue artifi airways, although repeatedly the obtained material was mildlycial ventilation, but airway pressures increased. There was no blood tinged. Also, the tracheotomy site continued to oozeexpansion of the left side of the chest on inspiration, and on blood. No atelectasis were seen on radiographs, and neitherauscultation no breath sounds were heard over her left chest, were there any abnormalities on physical examination of thesuggesting upper airway obstruction on the left side. Indeed, R289