Mokotedi Candy Masego, Balik Martin
Department of Anaesthesia and Intensive Care, 1st Medical Faculty, Charles University, Prague, Czech Republic.
BMJ Case Rep. 2017 Jul 18;2017:bcr-2017-219340. doi: 10.1136/bcr-2017-219340.
The mechanism of re-expansion pulmonary oedema (Re-PE) is unclear. There are multiple variables in play when evaluating the response to evacuation of pleural fluid. We present an educational case of a critically ill patient admitted for respiratory failure who was fully dependent on ventricular pacing set at a constant rate throughout the episode of Re-PE. The transthoracic echocardiography (TTE) showed an ejection fraction of 38%, moderate mitral regurgitation (MR), mildly dilated right ventricle and moderate pulmonary hypertension. A pleural tap evacuated 850 mL of transudate, which was followed by tachypnoea and deteriorating oxygenation. Another repeat TTE revealed a Re-PE with elevated left ventricular end-diastolic pressure, severe MR, increased pulmonary hypertension and a decrease in stroke volume. There were no parallel changes in ventilation modality, heart rate, fluid therapy and vasopressor dosage. The treatment was initiated with dobutamine. The patient was extubated the next day and was later discharged to the cardiology department.
复张性肺水肿（Re-PE）的机制尚不清楚。在评估胸腔积液引流反应时，有多个变量在起作用。我们展示了一个教育案例，一名因呼吸衰竭入院的重症患者，在整个Re-PE发作期间完全依赖于以恒定速率设置的心室起搏。经胸超声心动图（TTE）显示射血分数为38%，中度二尖瓣反流（MR），右心室轻度扩张和中度肺动脉高压。胸腔穿刺抽出850毫升漏出液，随后出现呼吸急促和氧合恶化。另一次重复TTE显示Re-PE伴有左心室舒张末期压力升高、严重MR、肺动脉高压增加和每搏输出量减少。通气方式、心率、液体治疗和血管升压药剂量没有平行变化。治疗从多巴酚丁胺开始。患者第二天拔管，后来出院到心内科。
