Successful adrenaline treatment of perioperative severe bronchospasm combined with a silent lung: two case reports

Silent lung is a rare and potentially fatal disease. It is a critical sign of strong bronchospasm or extensive mucus plug blockage, which can result in the obvious weakening of breathing sounds or even disappearance of breathing sounds. Silent lung has an acute onset and rapid progress, which seriously threatens the life of patients. It needs early diagnosis, timely and effective treatment to reverse the persistent severe bronchospasm of patients. If not handled in time, silent lung can cause rapid onset of severe hypoxemia, hypoxic brain injury, and even cardiac arrest. Few studies have been reported on the causes and specific treatments for silent lungs.

We report 2 rare cases of silent lung in this article and summarize the pathogenesis, inducing factors, clinical manifestations of perioperative silent lung. We also review the literature and discuss our solutions and propose other possible solutions for the treatment of silent lung emergencies in clinical settings in order to provide reference for clinical practice of anesthesiologists. Of the patients, 1 displayed a sudden decrease in ventilation volume, an increase in airway resistance, and was changed to pure oxygen. The manual ventilation failed, and there was no fluctuation of the thorax and no respiratory sound during auscultation. Cardiopulmonary resuscitation (CPR) was initiated when cardiac arrest was imminent after hypoxia. The other patient had high airway resistance after anesthesia-induced endotracheal intubation, could not be ventilated, and the carbon dioxide (CO₂) waveform at the end of breathing disappeared.

Both patients had severe bronchospasm; that is, silent lung. The 2 patients improved after hand-controlled ventilation and the administration of adrenaline and methylprednisolone, and ultimately recovered ventilation.