Acute pulmonary edema due to hypoxia during a difficult intubation in a rheumatoid arthritis patient

Jeong, Ji Seon; Jun, Jong‐Gab; Song, Hyo Jin; Choi, Sang Sik

doi:10.4097/kjae.2014.67.s.s74

Cited by 3 publications

(1 citation statement)

References 4 publications

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“…However, the use of medicines such as diuretics and steroids is heavily debated, and there are, as yet, no definitive guidelines on their use [ 15 ]. To the best of our knowledge, 1 patient with RA had acute pulmonary edema as a result of a DTI [ 16 ]. In that case, laryngeal mask airway-guided fiber-optic intubation was succeeded after failure of direct tracheal intubation and fiber-optic intubation.…”

Section: Discussionmentioning

confidence: 99%

Negative-Pressure Pulmonary Edema After Difficult Endotracheal Intubation in a Patient with Juvenile Rheumatoid Arthritis Undergoing Spigelian Hernia Surgery: A Case Report

et al. 2022

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Patient: Male, 35-year-old Final Diagnosis: Negative-pressure pulmonary edema Symptoms: Difficult airway management Medication:— Clinical Procedure: — Specialty: Anesthesiology • Critical Care Medicine Objective: Unusual clinical course Background: Difficult tracheal intubation (DTI) is common in patients with rheumatoid arthritis (RA) because of the subluxation of atlas and axis, the fusion of the cervical spine as a result of arthritis. We report a case of negative-pressure pulmonary edema (NPPE) caused by DTI in a patient with juvenile RA (JRA) who underwent surgery for spigelian hernia. Case Report: A 35-year-old man was referred to our department for repeated abdominal pain and a left-lower quadrant mass. Spigelian hernia was diagnosed with abdominal computed tomography (CT), and surgery was scheduled. Despite careful preoperative preparation and intubation strategy, fiber-optic intubation and laryngeal mask ventilation failed; nasal fiber-optic tracheal intubation was subsequently successfully performed. During induction, upper airway obstruction caused NPPE. CT findings showed bilateral infiltration and diffuse ground-glass opacity suggestive of pulmonary edema. Surgery for the spigelian hernia was canceled as the patient required intensive care as a result of NPPE. After 48 h of initiating treatment, the patient’s respiratory condition gradually improved. Seven days after DTI, he underwent laparoscopy-assisted surgery for the spigelian hernia. The patient was discharged after 2 weeks of hospitalization. Four years have passed since the surgical procedure; the outcome has remained favorable and there has been no recurrence. Conclusions: Normal ventilation may be the most important factor for preventing NPPE. It is vital that patients with RA receive treatment in an environment with advanced airway equipment and staff fully trained in its use. Similarly, the necessary staff and equipment for emergency cricothyroidotomies should also be readily available.

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Section: Discussionmentioning

confidence: 99%

Negative-Pressure Pulmonary Edema After Difficult Endotracheal Intubation in a Patient with Juvenile Rheumatoid Arthritis Undergoing Spigelian Hernia Surgery: A Case Report

et al. 2022

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Impact of hypoxia on male reproductive functions

et al. 2022

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Glucose-albumin ratio (GAR) as a novel biomarker for predicting postoperative pneumonia (POP) in older adults with hip fractures

Tang,

Ni,

Yao

et al. 2024

Sci Rep

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Postoperative pneumonia (POP) is a common complication after hip fracture surgery and is associated with increased mortality and other complications in elderly patients. This study aims to evaluate biomarkers, especially the glucose-albumin ratio (GAR), for predicting POP in elderly hip fracture patients. A total of 1279 elderly patients admitted to our hospital with hip fractures were included. We assessed 29 biomarkers and focused on GAR to determine its prognostic and predictive value for POP. Multivariable logistic regression and propensity score-matched analyses were conducted to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for POP, adjusting for potential confounders. Receiver operating characteristic (ROC) curves were utilized to determine the optimal cut-off of GAR for predicting POP. Among the biomarkers and combinations assessed, GAR demonstrated superior predictive capability for POP in elderly hip fracture patients. ROC analyses showed moderate predictive accuracy of GAR for POP, with an area under the curve of 0.750. Using the optimal cut-off of 0.175, the high GAR group was significantly associated with increased odds of POP (adjusted OR 2.14, 95%, CI 1.50–3.05). These associations remained significant after propensity score matching and subgroup analyses. Dose–response relationships between GAR and POP were observed. In conclusion, GAR may be a promising biomarker to predict POP risk in elderly hip fracture patients. Further studies are warranted to validate its clinical utility. However, this study has certain limitations, including its retrospective design, potential for selection bias due to the exclusion criteria, and the single-center nature of the study, which should be addressed in future prospective, multicenter studies.

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Acute pulmonary edema due to hypoxia during a difficult intubation in a rheumatoid arthritis patient

Cited by 3 publications

References 4 publications

Negative-Pressure Pulmonary Edema After Difficult Endotracheal Intubation in a Patient with Juvenile Rheumatoid Arthritis Undergoing Spigelian Hernia Surgery: A Case Report

Negative-Pressure Pulmonary Edema After Difficult Endotracheal Intubation in a Patient with Juvenile Rheumatoid Arthritis Undergoing Spigelian Hernia Surgery: A Case Report

Impact of hypoxia on male reproductive functions

Glucose-albumin ratio (GAR) as a novel biomarker for predicting postoperative pneumonia (POP) in older adults with hip fractures

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