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

Authors

• Henry Yung Respiratory Department, Cambridge University Hospitals, Cambridge, UK; Rayne Institute, University College London, London, UK
• Keshav Sharma Respiratory Department, Cambridge University Hospitals, Cambridge, UK
• William Flowers Respiratory Department, Cambridge University Hospitals, Cambridge, UK
• Malcolm Marquette Respiratory Department, Cambridge University Hospitals, Cambridge, UK
• Laura Starace Nutrition and Dietetics Team, Cambridge University Hospitals, Cambridge, UK
• Clare Sander Respiratory Department, Cambridge University Hospitals, Cambridge, UK
• Rowan Burnstein Neurocritical Care Unit, Cambridge University Hospitals, Cambridge, UK
• Jurgen Herre Respiratory Department, Cambridge University Hospitals, Cambridge, UK

h.yung@nhs.net

Keywords

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.