Acute Respiratory Distress Syndrome Following Anaphylactic Shock—“A Deadly Duel”—Case Report and Literature Review

Fernando, Ungamandadige P. M.; Dharmawardhane, Malmee P.; Subramaniam, Nishanthan; Srisothinathan, Nimalan; Gunathilake, Kukulagoda U. I. S.; Munasinghe, B. M.

doi:10.4236/ojanes.2021.112004

Cited by 7 publications

(6 citation statements)

References 10 publications

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“… 28 , 29 Notably, ARDS could happen in patients with supra-therapeutic doses of epinephrine due to increased pulmonary arterial pressure and pulmonary edema. 30 , 31 Five out of nine subcutaneous epinephrine cases and one inhaled epinephrine case was subsequently administered IV epinephrine. As the maximum plasma epinephrine concentration rose slowly in these cases, 32 the clinical symptoms were not relieved promptly.…”

Section: Discussionmentioning

confidence: 99%

Management of Suspected Life-Threatening Perioperative Anaphylaxis and Risk Factors for Near-Fatal and Fatal Outcomes: A Retrospective Study in China

Cai¹,

Liu²,

Wang³

et al. 2023

TCRM

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Purpose Perioperative anaphylaxis (POA) is an acute severe systemic hypersensitivity reaction characterized by life-threatening respiratory and circulatory collapse. In our previous study, we reported the epidemiology of suspected POA in China. In the present study, we aimed to elucidate the management and outcomes of these cases and further verify the risk factors for near-fatal and fatal outcomes. Patients and Methods This was a retrospective study of 447 cases of suspected life-threatening POA encountered at 112 tertiary hospitals in mainland China between September 2018 and August 2019. Patient characteristics, symptoms, duration of hypotension, treatments, and clinical outcomes were documented. Bivariate logistic regression was used to identify risk factors for near-fatal and fatal outcomes. Results Most cases of suspected POA (89.9%) were recognized and treated within 5 min. Epinephrine was administered as the initial treatment in 232 (51.9%) cases. Corticosteroids (26.6%), other vasoactive drugs (18.3%), and bronchodilators (1.6%) were also administered as the initial treatment instead of epinephrine. The initial dosage of epinephrine (median, 35 µg) was insufficient according to the anaphylaxis guidelines. On multivariable analysis, age ≥65 years (odds ratio [OR] 7.48; 95% confidence interval [CI]: 1.33–41.87, P =0.022), ASA physical status IV (OR 17.68; 95% CI: 4.53-68.94; P <0.001), and hypotension duration ≥15 min (OR 3.63; 95% CI: 1.11–11.87; P =0.033) were risk factors for fatal and near-fatal outcomes. Conclusion Most cases in this study were managed in a timely manner, but the epinephrine application should be optimized according to the guidelines. Age ≥65 years, ASA physical status IV, and long-term hypotension were risk factors for near-fatal and fatal outcomes.

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Section: Discussionmentioning

confidence: 99%

Management of Suspected Life-Threatening Perioperative Anaphylaxis and Risk Factors for Near-Fatal and Fatal Outcomes: A Retrospective Study in China

Cai¹,

Liu²,

Wang³

et al. 2023

TCRM

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“…Additionally, increased umbilical and cerebral arteries resistance index (RI) can signal poor outcomes, further complicating the management and outcome prediction in such cases. 19,20 Establishing consensus and protocols for managing anaphylaxis in pregnant women remains crucial, highlighting the need for standardized approaches across healthcare services. The presented case underscores the potential limitations of maternal stabilization without adrenaline, indicating the importance of effective and swift intervention in preventing adverse fetal outcomes.…”

Section: Discussionmentioning

confidence: 99%

Anaphylactic Shock Due to Prophylactic Antibiotics in Planned Sectio Cesarean : A Case Report

Porman Surtana Siahaan

2023

JARMHS

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Introduction: Anaphylactic reactions during pregnancy are complex to diagnose and manage, potentially ranging from mild symptoms to life-threatening situations for both the mother and fetus. With an incidence varying from 1.44 to 2.7 cases per 100,000 births and subtle, overlapping symptoms with other obstetric emergencies, accurate identification remains a challenge. Despite being underdiagnosed, severe anaphylactic events during pregnancy share symptoms with other critical conditions, making differentiation intricate. Prior reviews and recent data underscore the necessity for guidelines and public health actions, emphasizing the importance of vigilance and specific management strategies in obstetrics. Case report: This case involves Ny. S, a 33-year-old pregnant woman undergoing an elective C-section, who developed an allergic reaction to Cefazolin, necessitating an emergency procedure and subsequent ICU admission due to anaphylactic complications. Patient at 38 weeks pregnant, encountered an unexpected allergic reaction during a planned C-section, necessitating an emergency procedure. Post-surgery, she experienced severe complications, including pulmonary and laryngeal edema, requiring intensive care. With prompt medical attention and a comprehensive treatment plan, including medications and careful monitoring, her condition stabilized over several days. By October 21, 2023, she showed significant improvement, allowing her discharge with scheduled follow-up care. Discussion: The discussion encompasses the complexity of diagnosing anaphylaxis during pregnancy, highlighting challenges in laboratory confirmation, management protocols mirroring non-pregnant guidelines, and the importance of coordinated medical care to avert adverse maternal and fetal outcomes. It emphasizes the need for standardized protocols and consensus among healthcare providers to effectively manage maternal anaphylaxis, reflecting on the rarity of this condition and the potential risks it poses to both the mother and fetus. Conclusion: Anaphylactic reaction during an elective C-section, prompting urgent medical intervention involving mechanical ventilator support and meticulous care. Patient’s subsequent recovery and discharge, along with fluctuating lab results indicating an acute immune response, underscore the complexity of diagnosing and managing maternal anaphylaxis, emphasizing the need for standardized protocols and coordinated healthcare approaches.

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“…Anaphylactic reaction seemed the most likely at the postulated that inflammatory mediators released during anaphylaxis could cause lung damage, resulting in noncardiogenic pulmonary edema and ARDS. Additionally, the use of exogenous epinephrine for anaphylaxis, stimulates adrenergic receptors, constricting peripheral vasculature, and increasing left ventricular pressure, causing blood to back up to pulmonary vessels, resulting in cardiogenic pulmonary edema [14]. The global cardiac hypokinesis visualized on echocardiogram, coupled with the use of large-dose IV epinephrine makes flash pulmonary edema a likely sequelae of cardiac arrest and anaphylactic shock.…”

Section: Discussionmentioning

confidence: 99%

A Near-Fatal Anaphylactic Shock: Differential Diagnosis and Management

Ryan¹,

Sabry²

2023

Int J Anesthetic Anesthesiol

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Background: Severe anaphylactic reactions to midazolam and Clindamycin are exceedingly rare. Thorough surveillance, early recognition, and prompt intervention for these reactions are imperative due to the widespread use of both of these medications in the surgical setting. Case:We present the case of a 79-year-old male who was set to undergo an elective incisional hernia repair and received midazolam and clindamycin preoperatively, which was immediately followed by anaphylactic shock leading to cardiac arrest. His hospital stay was complicated by flash pulmonary edema and respiratory distress. On postoperative day eight, the patient's condition stabilized and was discharged. Conclusion:The widespread use of midazolam and clindamycin by anesthesia providers may make it appear that both agents are very safe for common use however, we highlight the rare but potentially disastrous adverse reactions that may occur from using these medications.Presented are the cardiovascular considerations of anaphylactic shock due to an unknown culprit and the appropriate interventions that took place to ensure the patient's survival.

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Acute Respiratory Distress Syndrome Following Anaphylactic Shock—“A Deadly Duel”—Case Report and Literature Review

Cited by 7 publications

References 10 publications

Management of Suspected Life-Threatening Perioperative Anaphylaxis and Risk Factors for Near-Fatal and Fatal Outcomes: A Retrospective Study in China

Management of Suspected Life-Threatening Perioperative Anaphylaxis and Risk Factors for Near-Fatal and Fatal Outcomes: A Retrospective Study in China

Anaphylactic Shock Due to Prophylactic Antibiotics in Planned Sectio Cesarean : A Case Report

A Near-Fatal Anaphylactic Shock: Differential Diagnosis and Management

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