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Images in thorax
Let air out of the bowel to allow more air in the lungs: surgical treatment of weaning failure
  1. Hugh Ip1,
  2. Wen Ling Woo2,
  3. Amir Darakhshan3,
  4. Nicholas Hart1
  1. 1Lane Fox Respiratory Service, St Thomas’ Hospital, Guy's and St Thomas’ NHS Foundation Trust, London, UK
  2. 2Department of Respiratory, Whittington Hospital, London, UK
  3. 3Guy's and St Thomas’ NHS Foundation Trust, London, UK
  1. Correspondence to Dr Hugh Ip, Respiratory Registrar, Lane Fox Respiratory Service, St Thomas’ Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK; Hughip{at}

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A 79-year-old man was electively admitted for a Whipple's procedure for a pancreatic cancer. Following surgery, he was extubated, but subsequently developed a hospital-acquired pneumonia with multiple organ failure requiring admission to the intensive care unit for organ support. After a protracted period of failed weaning from mechanical ventilation, he was transferred to a regional weaning centre 7 months after the initial operation. Since the surgery, the patient had complained of abdominal bloating and discomfort with distended bowel loops observed on the plain abdominal film. Because of frailty of the patient, a conservative management approach was taken, including high positive extrinsic pressure to enhance lung volume and the use of prokinetics, low-volume enteral feeding, regular aspiration of air from the nasogastric tube, sitting …

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  • HI and WLW are joint first authors.

  • Twitter Follow Nicholas Hart @NickHartThorax

  • Contributors NH, AH and HI managed the patient. HI and WLW drafted the manuscript. WLW prepared the images. All authors reviewed and revised the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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