Alternative to independent lung ventilation in severe refractory hypoxemia due to reexpansion pulmonary edema in the post-operative period of a cardiovascular surgery.
A Case Report
Abstract
Introduction: Pulmonary reexpansion edema (PRE) occurs after the drainage of large volumes of pleural effusion in a short period of time. In severe cases, it can produce refractory hypoxemia. Some authors propose in this scenarios independent lung ventilation and positioning. Due to the similar pathophysiology between acute respiratory distress syndrome and PRE , the rescue therapies proposed in this entity could be a valid alternative. However, this has not been reported in the literature before. For this reason, the objective of this presentation is to describe the treatment strategies and outcomes obtained in a case of refractory hypoxemia due to pulmonary reexpansion edema.
Case report: A 24 years old male patient who developed pulmonary reexpansion edema and severe refractory hypoxemia in the postoperative period of aortic valve replacement after massive hemothorax drainage. In this context, protective mechanical ventilation, esophageal manometry monitoring and prone position were decided. The patient evolved favorably by extubation on the eighth day of mechanical ventilation.
Conclusion: A different approach for reexpansion pulmonary edema succeeded in reversing the severe refractory hypoxemia caused by edema due to pulmonary reexpansion. It could be an alternative method to treat severe cases instead of independent lung ventilation.
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