Your browser doesn't support javascript.
loading
Diaphragm Ultrasound in Weaning From Mechanical Ventilation.
Kilaru, Deepti; Panebianco, Nova; Baston, Cameron.
Afiliação
  • Kilaru D; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA.
  • Panebianco N; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA.
  • Baston C; Department of Medicine, Perelman School of Medicine, University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA. Electronic address: Cameron.Baston@pennmedicine.upenn.edu.
Chest ; 159(3): 1166-1172, 2021 03.
Article em En | MEDLINE | ID: mdl-33309837
A 65-year-old man was admitted to the ICU for septic shock due to pneumonia. He remained on mechanical ventilation for 96 hours. His shock resolved, and he no longer required IV vasopressor therapy. His vital signs included a BP of 105/70 mm Hg, heart rate 85 beats/min, respiratory rate 22 breaths/min, and oxygen saturation 95%. His ventilator settings were volume control/assist control with a positive end-expiratory pressure of 5 and an Fio2 set to 40%. On these setting his blood gas showed an Pao2 of 75 mm Hg. He was following simple commands and had minimal tracheobronchial secretions. He was placed on a spontaneous breathing trial with a spontaneous mode of ventilation and pressure support of 7/5. He remained hemodynamically stable and showed no distress through the procedure, so he was extubated to 6 L oxygen by nasal cannula. Eighteen hours later, the patient was found to have increased work of breathing, with use of accessory respiratory muscles. A blood gas showed an elevated level of CO2, so the patient was reintubated. After intubation, the patient again appeared comfortable on minimal ventilator settings. Chest radiography before reintubation showed no new parenchymal process, but an elevated left diaphragm. After a thorough workup, it was determined that diaphragmatic weakness was the most likely reason for respiratory failure. The team questioned whether there was a way to have detected this before extubation.
Assuntos
Palavras-chave

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Paralisia Respiratória / Diafragma / Desmame do Respirador / Ultrassonografia Tipo de estudo: Diagnostic_studies / Etiology_studies Limite: Humans Idioma: En Revista: Chest Ano de publicação: 2021 Tipo de documento: Article País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Paralisia Respiratória / Diafragma / Desmame do Respirador / Ultrassonografia Tipo de estudo: Diagnostic_studies / Etiology_studies Limite: Humans Idioma: En Revista: Chest Ano de publicação: 2021 Tipo de documento: Article País de publicação: Estados Unidos