Pulmonary rehabilitation of a 72-year-old male with tracheostomy combined with unilateral tuberculous pleural effusion after cerebral infarction: A case report and literature review

Introduction: While poststroke rehabilitation primarily addresses motor, linguistic, cognitive, and swallowing impairments, pulmonary dysfunction (PD) is frequently neglected. PD following stroke, attributed to cortical-diaphragm pathway damage, can lead to increased mortality and prolonged hospitalization. Tracheostomy in such patients can exacerbate PD by increasing airway resistance and the risk of respiratory infections. This case study aims to report the successful integration of early pulmonary rehabilitation (PR) in a high-risk patient with poststroke tracheostomy complicated by unilateral tuberculous pleural effusion, underscoring its critical role in mitigating PD and improving outcomes. Patient concerns: A 72-year-old male with left-sided hemiplegia and dysphagia for over 3 months was admitted for rehabilitation following recurrent pulmonary infections post-cerebral infarction, which necessitated tracheostomy and indwelling tracheal cannula placement in the intensive care unit 3 months prior. Diagnoses: Cranial and thoracic computed tomography scans of the patient demonstrated infarctive lesions within the brainstem and the right semioval center, as well as evidence of infection in the lower lobe of the right lung. Additionally, atelectasis of the left lung and a significant amount of left-sided pleural effusion were observed. The patient’s T-cell spot test confirmed a positive result for tuberculosis infection. Due to the presence of dysphagia and bile reflux, a nasojejunal tube was inserted to facilitate enteral feeding. Furthermore, a tracheostomy was performed with the placement of an indwelling tracheostomy tube to manage respiratory difficulties. The patient was subsequently diagnosed with poststroke tracheostomy complicated by left-sided pleural effusion. Interventions: For this elderly patient who underwent tracheostomy following a cerebral infarction and subsequently developed pleural effusion, our team performed an integrated rehabilitation evaluation and treatment protocol, prioritizing PR strategies. Outcomes: The patient’s thoracic drainage tube and tracheostomy tube were successfully removed, with subsequent improvements in pulmonary function and overall motor function, leading to a reduction in the level of dependence on daily living activities. Lessons: For patients with pulmonary dysfunction following a stroke, PR should be considered an integral component of the rehabilitation plan. This approach is crucial for enhancing respiratory function, improving overall physical capacity, and thereby accelerating the recovery process.