British journal of anaesthesia
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We describe a case of severe acute lung injury after attempted strangulation. The patient presented initially with cerebral irritability and florid, noncardiogenic pulmonary oedema which were followed by a prolonged period of the adult respiratory distress syndrome, severe sepsis and multiple system organ failure, although the patient eventually survived. The pulmonary injury following strangulation is proposed to be a result of the generation of marked subatmospheric pressures within the lungs during vigorous inspiration against an obstructed airway, although the processes involved in the so-called neurogenic pulmonary oedema are difficult to exclude.
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In 20 adult patients (18 male) who presented for thoracotomy, the trachea was intubated using Mallinckrodt disposable double-lumen tubes (18 large and two medium). The endobronchial cuff was inflated by a trained operating department assistant using an air-filled syringe. ⋯ Mean initial cuff pressure was 69.3 (SEM 6.0) mm Hg, whereas the mean minimum cuff pressure was 29.5 (4.0) mm Hg (P < 0.0001). The results suggest that the method described of inflating the endobronchial cuff may lead to overinflation and subsequent excessive pressure on the endobronchial wall.