Food for Thought: Dietary Intervention in a Rare Cause of Severe Ventilatory Failure

Henry Yung; Keshav Sharma; William Flowers; Malcolm Marquette; Laura Starace; Clare Sander; Rowan Burnstein; Jurgen Herre

doi:10.12890/2020_001523

Food for Thought: Dietary Intervention in a Rare Cause of Severe Ventilatory Failure

Eur J Case Rep Intern Med. 2020 Mar 26;7(5):001523. doi: 10.12890/2020_001523. eCollection 2020.

Authors

Henry Yung^{1

2}, Keshav Sharma¹, William Flowers¹, Malcolm Marquette¹, Laura Starace³, Clare Sander¹, Rowan Burnstein⁴, Jurgen Herre¹

Affiliations

¹ Respiratory Department, Cambridge University Hospitals, Cambridge, UK.
² Rayne Institute, University College London, London, UK.
³ Nutrition and Dietetics Team, Cambridge University Hospitals, Cambridge, UK.
⁴ Neurocritical Care Unit, Cambridge University Hospitals, Cambridge, UK.

Abstract

Plastic bronchitis is a rare condition characterised by endobronchial cast formation. We report the case of a 53-year-old women who deteriorated following an elective bronchoscopy procedure. She developed refractory ventilatory failure and required repeated bronchoscopy, which identified thick tenacious casts as the cause of her airway compromise. She did not respond to conventional therapies including endoscopic clearance, mucolytic therapy and nebulised tissue plasminogen activator (TPA). Total parenteral nutrition and a fat-free enteral diet were instituted while the patient was on extracorporeal membrane oxygenation (ECMO), which led to substantial improvement in her condition and demonstrated the importance of dietary strategies in this case.

Learning points: Plastic bronchitis can rarely present in adults with acute ventilatory failure and life-threatening airway obstruction.Although there are no established guidelines on management, dietary intervention (e.g., a fat-free diet) should be strongly considered as a therapeutic option.Extracorporeal membrane oxygenation (ECMO) is feasible and should be considered in plastic bronchitis with airway compromise.

Keywords: Plastic bronchitis; asthma; bronchial casts; extracorporeal membrane oxygenation; mechanical ventilation.