RESUMEN
Severe chest trauma often requires immediate intervention, typically involving open chest surgery. However, advancements in medical technology offer alternative approaches, such as endovascular therapy and venovenous extracorporeal membrane oxygenation (VV-ECMO). In a recent case, a middle-aged male cyclist was admitted after colliding with a vehicle, presenting in shock with multiple injuries, including cerebral contusion and rib fractures. Despite initial treatments such as chest tubes and blood transfusions, his condition remained unstable, with worsening respiratory failure and hemorrhagic shock. A multidisciplinary team devised a comprehensive treatment plan, utilizing VV-ECMO for oxygenation support, a bronchial blocker to localize the hematoma, and interventional radiology for hemothorax hemostasis. These interventions successfully stabilized the patient without resorting to open chest surgery. Endovascular therapy, alongside bronchial blockers, facilitated adequate hemostasis and hematoma localization, avoiding invasive procedures. VV-ECMO plays a crucial role in maintaining oxygenation during respiratory failure. Strategic anticoagulation with nafamostat mesylate prevented clotting in the ECMO circuit. This case highlights the effectiveness of minimally invasive strategies in managing severe chest trauma, preserving lung function, and improving outcomes. In refractory cases, VV-ECMO acts as a bridge to stabilize respiratory status before definitive treatment, while bronchial blockers localize hematomas, reducing the need for surgery. Interventional radiology offers a less invasive option for achieving hemostasis. Collaboration among medical specialties and innovative technologies is critical to successfully navigating complex chest trauma cases.
RESUMEN
AIM: Phenobarbital overdose can cause coma and even death. The consciousness disturbance is often prolonged due to its long half-life. In this study, we investigated the efficacy of direct hemoperfusion (DHP) for the removal of phenobarbital by measuring the blood levels of phenobarbital. METHODS: Study subjects included five patients with phenobarbital poisoning who were transferred to our hospital. Direct hemoperfusion was carried out in three of the five patients (six times in total), and the elimination rate was calculated by measuring the blood levels before and after DHP. Furthermore, the disappearance rate of phenobarbital without DHP was calculated in all five patients (seven times in total) for comparison with the elimination rate. RESULTS: The elimination rate of phenobarbital with DHP was significantly higher than the disappearance rate without DHPï¼. CONCLUSION: This study suggests that early introduction of DHP should be considered as a treatment option for phenobarbital poisoning.
RESUMEN
Continuous venovenous hemodiafiltration is the modality of choice for acute blood purification therapy at almost all medical institutions in Japan. Nafamostat mesilate, an ultrashort-acting anticoagulant, is widely used for anticoagulation. Due to restrictions imposed by national health insurance, Japanese institutions use an effluent flow rate of 15 mL/kg/h, which is lower than the standard effluent flow rate used in the West. In addition, hemofilters are believed to adsorb cytokines, and thus some institutions also proactively perform continuous renal replacement therapy with a hemofilter at an early stage for cytokine modulation in patients with sepsis. Although some aspects of these Japanese practices differ greatly from Western practices, there has not been much evidence to support current standard methods. Therefore, Japanese researchers must continue working to produce evidence for those methods, at least those that are widely used in Japan.