Pulmonary Emergencies ERS monograph Pulmonary Emergencies This Monograph, written by well recognised experts in the field, provides a comprehensive overview of pulmonary emergencies A broad range of different respiratory emergencies is covered, from pneumothorax, pulmonary embolism, right heart failure and haematothorax to acute exacerbations of diseases such as asthma and chronic obstructive pulmonary disease Recent developments in treatment strategies for acute pulmonary problems are also discussed in detail, with chapters on topics such as high-flow nasal cannula oxygen therapy, extracorporeal carbon dioxide removal and noninvasive ventilation ISBN 978- 1- 84984- 073- Print ISBN: 978-1-84984-073-6 Online ISBN: 978-1-84984-074-3 December 2016 €60.00 781849 840736 Edited by Leo Heunks, Alexandre Demoule and Wolfram Windisch ERS monograph 74 Print ISSN: 2312-508X Online ISSN: 2312-5098 ERS monograph Pulmonary Emergencies Edited by Leo Heunks, Alexandre Demoule and Wolfram Windisch Editor in Chief Robert Bals This book is one in a series of ERS Monographs Each individual issue provides a comprehensive overview of one specific clinical area of respiratory health, communicating information about the most advanced techniques and systems required for its investigation It provides factual and useful scientific detail, drawing on specific case studies and looking into the diagnosis and management of individual patients Previously published titles in this series are listed at the back of this Monograph ERS Monographs are available online at www.erspublications.com and print copies are available from www.ersbookshop.com Continuing medical education (CME) credits are available through many issues of the ERS Monograph Following evaluation, successful Monographs are accredited by the European Board for Accreditation in Pneumology (EBAP) for CME credits To earn CME credits, read the book of your choice (it is clearly indicated on the online table of contents whether CME credits are available) then complete the CME question form that is available at www.erseducation.org/e-learning/cme-tests.aspx Editorial Board: Antonio Anzueto (San Antonio, TX, USA), Leif Bjermer (Lund, Sweden), John R Hurst (London, UK) and Carlos Robalo Cordeiro (Coimbra, Portugal) Managing Editors: Rachel White and Catherine Pumphrey European Respiratory Society, 442 Glossop Road, Sheffield, S10 2PX, UK Tel: 44 114 2672860 | E-mail: Monograph@ersj.org.uk Published by European Respiratory Society ©2016 December 2016 Print ISBN: 978-1-84984-073-6 Online ISBN: 978-1-84984-074-3 Print ISSN: 2312-508X Online ISSN: 2312-5098 Typesetting by Nova Techset Private Limited Printed by Page Bros Ltd, Norwich, UK All material is copyright to European Respiratory Society It may not be reproduced in any way including electronic means without the express permission of the company Statements in the volume reflect the views of the authors, and not necessarily those of the European Respiratory Society, editors or publishers This journal is a member of and subscribes to the principles of the Committee on Publication Ethics ERS monograph Contents Pulmonary Emergencies Number 74 December 2016 Preface v Guest Editors vii Introduction x List of abbreviations xi Clinical entities Pneumothorax Steve Walker and Nick Maskell Pulmonary embolism 15 Stefano Barco and Stavros V Konstantinides Right heart failure 32 Benjamin Sztrymf, Constance Vuillard, Athénaïs Boucly, Elise Artaud-Macari, Caroline Sattler, David Amar, Xavier Jaïs, Olivier Sitbon, Marc Humbert and Laurent Savale Acute exacerbations of COPD 48 Alison Patricia Butler, Laura-Jane E Smith and Alexander John Mackay Acute exacerbations of asthma 66 Nirav R Bhakta and Stephen C Lazarus Hypercapnic respiratory failure in non-COPD 86 Neeraj M Shah and Patrick B Murphy Severe community-acquired pneumonia 101 Adamantia Liapikou, Catia Cilloniz, Adrian Ceccato and Antoni Torres Acute exacerbations of interstitial lung disease 117 Marcel Veltkamp and Jan C Grutters Severe haemoptysis Muriel Fartoukh, Guillaume Voiriot, Samuel Hadad, Hicham Masmoudi, Jalal Assouad, Marie-France Carette, Antoine Khalil and Antoine Parrot 132 10 Foreign body aspiration and inhalation injury 151 Erik H.F.M van der Heijden, Paul C Fuchs and Jan-Philipp Stromps 11 Haematothorax 161 Erich Stoelben, Axel Gossmann and Servet Bölükbas Acute pulmonary interventions 12 High-flow nasal cannula oxygen therapy 171 Rémi Coudroy, Jean-Pierre Frat and Arnaud W Thille 13 Acute noninvasive ventilation 186 Rosanna Vaschetto, Federico Longhini and Paolo Navalesi 14 Extracorporeal carbon dioxide removal 200 Christian Karagiannidis, Stefan Kluge, Stephan Strassmann and Wolfram Windisch 15 Acute bronchoscopy 209 Raffaele Scala 16 Chest tube insertion Sanjay Adlakha, Mark Roberts and Nabeel Ali 229 ERS | monograph Preface Robert Bals Emergency situations in pulmonary medicine are critical for the patient and often stressful for the care providers The most important factor in the successful management of such situations is to be prepared Interruption of the function of the lung immediately results in an emergency situation In the case of severe impairment of gas exchange, a catastrophic outcome will occur within a few minutes if adequate measures are not started The management of respiratory acute situations is a core capability of respiratory and emergency medicine Physicians in all areas of pulmonary medicine face critical situations daily Maintaining the ability to manage emergencies adequately requires keeping knowledge up to date and training in critical procedures In addition to the basic principles in this area, a number of new techniques and procedures have been developed in recent years In contrast to the importance of this subject, there are only a few comprehensive textbooks available This ERS Monograph aims to provide the reader with a detailed overview of emergencies in pulmonary care, from a viewpoint close to the bedside The book is split into two sections The first section, on clinical entities, covers the most important emergency situations, while the second section, on acute pulmonary interventions, focuses on key techniques This structure allows readers to learn systematically or to refresh their knowledge of the theory of pulmonary emergency management, including bedside interventions Together with practical training and structural developments, this ERS Monograph will enable physicians and other healthcare providers to treat their patients safely in critical situations I would like to thank the Guest Editors, Leo Heunks, Alexandre Demoule and Wolfram Windisch, who have worked very successfully to select these topics and integrate them into a comprehensive book I would also like to thank all the authors for their work I am sure that this excellent ERS Monograph will Copyright ©ERS 2016 Print ISBN: 978-1-84984-073-6 Online ISBN: 978-1-84984-074-3 Print ISSN: 2312-508X Online ISSN: 2312-5098 ERS Monogr 2016; 74: v–vi DOI: 10.1183/2312508X.10018416 v be useful in clinical practice for a broad range of respiratory physicians and will help to improve the care of our patients Disclosures: R Bals has received grants from the German Research Ministerium and the Deutsche Forschungsgemeinschaft He has also received personal fees from GSK, AstraZeneca, Boehringer Ingelheim and CSL Behring vi ERS | monograph Guest Editors Leo Heunks Leo Heunks is professor of intensive care medicine at the VU University Medical Center Amsterdam (Amsterdam, the Netherlands) He received his undergraduate training and MD at the Radboud University (Nijmegen, the Netherlands) From 1996 to 2000, he was a PhD student in respiratory physiology During the PhD programme he visited the Mayo Clinic (Rochester, MN, USA) for months to study skeletal muscle single fibre mechanics and intracellular calcium imaging (with mentor Gary Sieck) He trained as a pulmonologist at the Radboud University Medical Center from 2000 to 2006, followed by a 2-year fellowship in intensive care medicine, and became consultant in intensive care at the same hospital He was co-founder of the first specialised ventilator-weaning unit in the Netherlands and chair of the Dutch guideline for difficult weaning In 2016, he moved to the VU University Medical Center Amsterdam, Dept of Intensive Care His research interests include effects of critical illness on respiratory muscle function, mechanical ventilation, weaning from the ventilator and ARDS He has spent research fellowships at Loyola University Medical Center (Chicago, IL, USA) and St Michael’s Hospital, Toronto (ON, Canada) In both clinical work and research, he promotes the understanding of physiological principles Only when we are willing to understand the underlying physiology can we conduct meaningful research and optimal patient care Currently, Leo Heunks is secretary of European Respiratory Society assembly (respiratory intensive care) Copyright ©ERS 2016 Print ISBN: 978-1-84984-073-6 Online ISBN: 978-1-84984-074-3 Print ISSN: 2312-508X Online ISSN: 2312-5098 ERS Monogr 2016; 74: vii–ix DOI: 10.1183/2312508X.10018216 vii Alexandre Demoule Alexandre Demoule is professor of intensive care medicine at the Pierre and Marie Curie University Medical Centre in Paris (France) He is the director of the medical ICU, the step-down unit and the weaning centre within the Dept of Pneumology and Intensive Care Medicine, La Pitié-Salpêtrière hospital in Paris He was trained in pneumology and physiology at the Pierre and Marie Curie University under the supervision of Thomas Similowski and in intensive care medicine at Paris-Est University in Créteil, where he was also a research fellow (2001–2002) in mechanical ventilation with Laurent Brochard From 2003 to 2006, he was a PhD student in respiratory physiology at the Pierre and Marie Curie University During the PhD programme he spent 1.5 years at the Meakins-Christie Laboratories, McGill University (Montreal, QC, Canada), under the supervision of Basil Petrof His main research field is patient–ventilator interactions It involves specific research topics such as brain–ventilator interactions, the impact of mechanical ventilation on respiratory sensations and comfort, and respiratory muscle dysfunction in mechanically ventilated patients He also conducts clinical studies on noninvasive mechanical ventilation in acute respiratory failure and on new modes of mechanical ventilation His research projects are conducted within UMR_S 1158, a joint research unit between Pierre and Marie Curie University and the French National Institute of Health and Medical Research (Inserm) Alexandre Demoule is the chair of the annual meeting of the French Intensive Care Society He has organised several conferences on mechanical ventilation, is co-author of guidelines in the field of intensive care medicine and serves as an invited speaker at international conferences Wolfram Windisch Wolfram Windisch is the medical director of the Dept of Pneumology and Critical Care Medicine, Clinic of Cologne (Cologne, Germany), and holds the professorial chair for Pneumology at the University of Witten/Herdecke (Cologne) His department is specifically dedicated to the acute and chronic treatment of respiratory failure, invasive and noninvasive mechanical ventilation, extracorporeal lung assist, weaning from mechanical ventilation and sleep medicine In addition, his other main focuses are COPD/asthma, thoracic oncology, interstitial lung diseases, infectious diseases and cystic fibrosis His research interests include respiratory physiology, all aspects of mechanical ventilation, monitoring of respiratory function in the acute and viii chronic setting, and health-related quality of life in patients with severe chronic respiratory failure In addition, Wolfram Windisch has chaired the German Interdisciplinary Society of Home Mechanical Ventilation, the group for noninvasive ventilatory support within assembly of the European Respiratory Society, and the section for intensive care medicine of the German Society of Pneumology and Ventilation He has organised several symposia and conferences on mechanical ventilation and serves as an invited speaker at national and international conferences He also serves as the responsible author for the German guidelines for noninvasive and invasive mechanical ventilation for treatment of chronic respiratory failure, and has served as a co-author for the German guidelines on acute NIV and for the German guidelines on prolonged weaning ix ERS MONOGRAPH | PULMONARY EMERGENCIES 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 226 Haenel JB, Moore FA, Moore EE, et al Efficacy of selective intrabronchial air insufflation in acute lobar collapse Am J Surg 1992; 164: 501–505 Tsao TC, Tsai YH, Lan RS, et al Treatment for collapsed lung in critically ill patients Selective intrabronchial air insufflation using the 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18: 712 Lucangelo U, Vassallo FG, Marras E, et al High-flow nasal interface improves oxygenation in patients undergoing bronchoscopy Crit Care Res Pract 2012; 2012: 506382 Brimacombe J, Dunbar-Reid K The effect of introducing fibreoptic bronchoscopes on gas flow in laryngeal masks and tracheal tubes Anaesthesia 1996; 51: 923–928 MacIntyre NR, Ramage JE, Follett JV Jet ventilation in support of fiberoptic bronchoscopy Crit Care Med 1987; 15: 303–307 Ramanathan S, Sinha K, Arismendy J, et al Humidification and airway pressures during high-frequency jet ventilation delivered through the suction-biopsy channel of a flexible bronchofiberscope Crit Care Med 1984; 12: 820–823 227 ERS MONOGRAPH | PULMONARY EMERGENCIES 121 Flatau E, Lewinsohn G, Konichezky S, et al Mechanical ventilation in fiberoptic-bronchoscopy: comparison between high frequency positive pressure ventilation and normal frequency positive pressure ventilation Crit Care Med 1982; 10: 733–735 122 Kerwin AJ, Croce MA, Timmons SD, et al Effects of fiberoptic bronchoscopy on intracranial pressure in patients with brain injury: a prospective clinical study J Trauma 2000; 48: 878–882 123 Peerless JR, Snow N, Likavec MJ, et al The effect of fiberoptic bronchoscopy on cerebral hemodynamics in patients with severe head injury Chest 1995; 108: 962–965 124 Previgliano IJ, Ripoll PI, Chiappero G, et al Optimizing cerebral perfusion pressure during fiberoptic bronchoscopy in severe head injury: effect of hyperventilation Acta Neurochir Suppl 2002; 81: 103–105 Disclosures: None declared 228 | Chapter 16 Chest tube insertion Sanjay Adlakha, Mark Roberts and Nabeel Ali Chest tube placement into the pleural cavity is performed to drain abnormal collections of air or fluid, or as a means to instil medications to perform pleurodesis The choice of chest tube and insertion site depends on the indication for placement and the nature of the fluid/air to be drained Small drains should be used for pneumothorax, free-flowing pleural effusions and pleural infection, and analgesia should be considered as a pre-medication It is strongly recommended that all chest tubes for fluid should be inserted under image guidance The tube should be inserted using full aseptic technique, and substantial force should never be used Blunt dissection should be employed in cases of trauma or insertion of large-bore drains Chest tubes should be managed on wards familiar with their management, and checked daily for fluid drainage volumes and any signs of wound infection, and documented for swinging and/or bubbling The chest tube should be removed once pneumothorax has resolved and fluid drainage has decreased to