TY - JOUR A2 - Chen, Tun-Chieh AU - Purewal, Jaskaran K. AU - Sakul, N. F. N. AU - Balabbigari, Nikhita R. AU - Nenninger, Alberto AU - Kotecha, Nisha PY - 2020 DA - 2020/03/11 TI - One Lung Soldier:SP - 5476794 VL - 2020 AB -肺切除术后综合征包括纵隔移位，通过压缩主支气管和远端气管导致动态气道阻塞。少数病例报告描述了肺切除术后综合征患者的ARDS发展。Reeb等人(2017)描述了肺切除术后急性呼吸窘迫综合征(ARDS)的死亡率在33%至88%之间。一个人可能会遇到困难插管和通气，因为参数基于理想体重可能不适用于。卧位通气和ECMO已成功应用于个别病例。我们提出了这样一个案例，并强调了管理方面的挑战。一名70岁越南退伍军人，30年前曾行右侧全肺切除术，表现为发热、咳嗽及呼吸困难。体格检查:体温36.3℃，血压162/73，心率145 BPM，呼吸RR 22次/分钟。1.72米，重78公斤，右肺音，左肺音。 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. SN - 2090-6846 UR - https://doi.org/10.1155/2020/5476794 DO - 10.1155/2020/5476794 JF - Case Reports in Pulmonology PB - Hindawi KW - ER -