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A Man in His 60s With Pneumonia and Multiple Reintubation Attempts

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

A man in his 60s was admitted because of pneumonia with respiratory failure. He was intubated on day 3 and extubated on day 7. On day 9, respiratory acidosis was noted. However, reintubation of the patient was difficult; a total of 3 intubation attempts were made. After successful reintubation, through written communication, the patient reported symptoms of dyspnea, chest pain, and neck pain during periods of daily sedation interruption. Physical examination demonstrated upper trunk tissue distention and crepitus on palpitation. Chest computed tomography revealed pneumopericardium, subcutaneous emphysema, pneumothorax, and pneumoperitoneum (Figure).

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Li-Chien Chang, MD, Department of Internal Medicine, Armed Forces Taichung General Hospital, No. 348, Section 2, Zhongshan Road, Taiping District, Taichung City 411, Taiwan (corrauthor098@gmail.com).

Conflict of Interest Disclosures: Drs Tsai, Lai, and Chang reported receiving processing and editing fee assistance from the Department of Medical Education and Research, Taichung Armed Forces General Hospital. No other disclosures were reported.

Additional Contributions: We thank Chun-Wen Chen, MD, Department of Radiology, Taichung Armed Forces General Hospital, and Mr Hsin-Yi Pan, Department of Optometry, Asia University, for their assistance with image review and processing, respectively. They were not financially compensated for their contributions.

References
1.
Brander  L , Ramsay  D , Dreier  D , Peter  M , Graeni  R .  Continuous left hemidiaphragm sign revisited: a case of spontaneous pneumopericardium and literature review.   Heart. 2002;88(4):e5. doi:10.1136/heart.88.4.e5PubMedGoogle Scholar
2.
Gould  JC , Schurr  MA .  Tension pneumopericardium after blunt chest trauma.   Ann Thorac Surg. 2001;72(5):1728-1730. doi:10.1016/S0003-4975(01)02647-9PubMedGoogle ScholarCrossref
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