Ventilación en posición prono prolongada como alternativa en el tratamiento del síndrome de distrés respiratorio agudo grave posneumonectomía: Caso clínico

Cornejo, Rodrigo; Romero, Carlos; Goñi, Daniela; Luengas, Rafael; Llanos, Osvaldo; Gálvez, Ricardo; Castro, Jéssica

doi:10.4067/s0034-98872009001000011

Cited by 3 publications

(2 citation statements)

References 43 publications

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“…However, there is limited literature regarding postpneumonectomy patients affected with ARDS and the subsequent effect of proning. While prone ventilation was not an option for our patient due to hemodynamic instability, case reports have demonstrated significant improvement in similar patients [8,9]. Furthermore, it is uncertain whether typical ventilation strategies used in ARDS management may be as effective due to a combination of the underlying pathophysiology of postpneumonectomy syndrome and ARDS.…”

Section: Discussionmentioning

confidence: 93%

One Lung Soldier: A Ventilation Conundrum in a Postpneumonectomy Syndrome Complicated by Acute Respiratory Syndrome

Purewal

Sakul

Balabbigari

et al. 2020

Case Reports in Pulmonology

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Postpneumonectomy syndrome involves mediastinal shift causing dynamic airway obstruction via compression of the main bronchus and distal trachea. A few case reports describe the development of ARDS in patients with postpneumonectomy syndrome. Reeb et al. (2017) describe the mortality of postpneumonectomy ARDS anywhere from 33% to 88%. One may encounter difficulty in intubation and ventilation as parameters based on ideal body weight may not apply. Prone positioning ventilation and ECMO have been successfully used in isolated cases. We present such a case and highlight challenges in management. A 70-year-old male Vietnam veteran with remote history of right pneumonectomy thirty years prior presented with fever, cough, and dyspnea. Physical exam was significant for T 36.3°C, BP 162/73, heart rate 145 BPM, RR 22 breaths/minute, ht. 1.72 m, and wt. 78 kg, with transmitted right lung sounds and rhonchi on the left. Labs showed WBC 23.92/nL and procalcitonin 0.84 ng/mL. CXR showed left infiltrate and opacification of right hemithorax with right mediastinal shift. EKG showed atrial fibrillation. He was started on broad spectrum antibiotics for pneumonia, but deteriorated, and was intubated for respiratory distress from ARDS. Vasopressors were initiated for shock. Given the history of pneumonectomy, he was initially ventilated with lower tidal volumes (320 mL). However, incremental changes were made to tidal volumes, and ETT was repositioned several times for hypoxia. Epoprostenol and cisatracurium were also initiated. Positional changes would lead to sudden desaturation; hence, prone positioning ventilation was not done. He was not considered for ECMO due to his pneumonectomy status. Unfortunately, his condition worsened progressively and he expired. The guidelines for ARDS are well established. However, postpneumonectomy patients are unique as seen in our patient. It is unclear whether an endobronchial tube advanced into the left bronchus could have helped difficult airway management resulting from suspected postpneumonectomy syndrome as suggested by CXR. Higher tidal volumes were also unsuccessful in alleviating hypoxia and led to persistently elevated plateau pressures and driving pressures as high as 23, which was inconsistent with our goal of lung protective ventilation. Few case reports describe the successful use of prone positioning ventilation or ECMO in postpneumonectomy patients with ARDS. Although not well studied, low tidal volumes supported with ECMO may have been a favorable strategy for our patient.

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Section: Discussionmentioning

confidence: 93%

One Lung Soldier: A Ventilation Conundrum in a Postpneumonectomy Syndrome Complicated by Acute Respiratory Syndrome

Purewal

Sakul

Balabbigari

et al. 2020

Case Reports in Pulmonology

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“…Segundo Amato et al (2007) a maioria dos pacientes com SDRA responde à posição prona com melhora da oxigenação, que pode persistir após o retorno à posição em decúbito dorsal. A ventilação pulmonar em prona pode ser uma forma segura de tratamento para salvar vidas em casos graves de SDRA (CORNEJO et al, 2009;CORNEJO et al, 2010). Gattinoni et al (2001) em seu ensaio clínico multicêntrico realizado com 304 pacientes, dos quais 152 foram aleatorizados para utilizarem posição prona por, no mínimo, seis horas por dia, durante 10 dias, confirmou uma melhora da oxigenação nesse grupo, comparado ao grupo convencional.…”

Section: Discussionunclassified

Análise Das Caracteristicas Clínicas Dos Pacientes Com Síndrome Do Desconforto Respiratório Agudo Submetidos À Posição Prona: Estudo Retrospectivo

Azevedo

Queiroz²,

Oliveira

et al. 2020

Rev. Expr. Catól. Saúde

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A posição prona é o contado total da região anterior do corpo com a maca (cama), é um método aparentemente seguro e simples que melhora a troca gasosa e oxigenação por ocorrer a diminuição da complacência da parede torácica. Nos últimos anos essa posição vem sendo utilizada nos pacientes com Síndrome do Desconforto Respiratório Agudo para tentar promover benefícios, como drenagem postural, mudança do padrão de movimento diafragmático, aumento da capacidade funcional residual e melhora da pressão arterial de oxigênio. O estudo teve como objetivo analisar as características clínicas dos pacientes com Síndrome do Desconforto Respiratório Agudo submetidos aposição prona. Trata-se de um estudo retrospectivo, descritivo, documental e com análise quantitativa dos resultados. Foram avaliados 16 prontuários de pacientes internados na Unidade Terapia Intensiva no período de janeiro de 2008 a dezembro de 2016, independentemente de idade e sexo. O sexo predominante do estudo foi masculino (62,5%; n = 10). Evidenciou-se que 100% (n = 16) dos indivíduos da amostra apresentavam patologias associadas ao sistema respiratório como origem da SDRA. Durante a internação, 78% (n = 12) dos pacientes analisados foram pronados uma vez por 11,5 horas, 12,5% (n = 2) duas vezes por 18 horas e 12,5% (n = 2) três vezes por 16 horas, esse último obtendo melhora nas gasometrias, destacando assim, que o tempo se faz importante. Conclui-se que a posição prona contribui no tratamento de pacientes com SDRA com a finalidade de melhorar a oxigenação e minimizar as complicações decorrentes da hipoxemia, através do maior tempo em prono.

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Pneumonectomy subjects with acute respiratory distress syndrome: what to do

Unnikrishnan

2015

Eur Respir Rev

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Ventilación en posición prono prolongada como alternativa en el tratamiento del síndrome de distrés respiratorio agudo grave posneumonectomía: Caso clínico

Cited by 3 publications

References 43 publications

One Lung Soldier: A Ventilation Conundrum in a Postpneumonectomy Syndrome Complicated by Acute Respiratory Syndrome

One Lung Soldier: A Ventilation Conundrum in a Postpneumonectomy Syndrome Complicated by Acute Respiratory Syndrome

Análise Das Caracteristicas Clínicas Dos Pacientes Com Síndrome Do Desconforto Respiratório Agudo Submetidos À Posição Prona: Estudo Retrospectivo

Pneumonectomy subjects with acute respiratory distress syndrome: what to do

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