TITLE:
Airway Pressure Release Ventilation Improves Oxygenation in a Patient with Pulmonary Hypertension and Abdominal Compartment Syndrome
AUTHORS:
Arturo G. Torres, Robert P. Tostenrud, Eugenio Lujan
KEYWORDS:
Airway Pressure Release Ventilation; Mechanical Ventilation; Abdominal Compartment Syndrome; Pulmonary Hypertension; Positive Pressure Ventilation
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.3 No.1,
January
31,
2013
ABSTRACT: The following case describes the
favorable application of airway pressure release ventilation (APRV) in a
patient with pulmonary hypertension who developed respiratory failure and
abdominal compartment syndrome after abdominal closure from an incarcerated
umbilical hernia. A 66-year-old male with past medical history of
restrictive lung disease, obstructive sleep apnea and pulmonary hypertension,
presented to the operating room for an incarcerated inguinal hernia. After
abdominal closure, he gradually developed decreased oxygen saturation and
hypotension. APRV was initiated during post operative day 2 after inability to
maintain adequate oxygen saturation with resultant hypotension on pressure
control ventilation with varying degrees of positive end expiratory pressure
and 100% inspired oxygen concentration. The initial set high pressure on APRV
was 35 mm Hg.
Yet, in lieu of decreasing lung compliance, it peaked at 50 mm Hg. Eventually, inhaled Nitric Oxide
was initiated post operative day 3 due to increasing pulmonary arterial pressures.
A bedside laparotomy was eventually performed when bladder pressures peaked to 25 mm Hg. APRV gradually and temporally
improved the oxygen saturation and decreased the pulmonary arterial pressures
with subsequent increase in systemic blood pressures. APRV promoted alveolar
recruitment and decreased the shunting associated with abdominal compartment
syndrome. Better oxygen saturations lead to increases in blood pressure by
decreasing the effects of hypoxic pulmonary vasoconstriction on the right
ventricle (RV). In patients with decreasing lung compliance and pulmonary
comorbidities, APRV appears safe and allows for improve oxygenation, after
failure with conventional modes of ventilation.