Xin Ya See, Zehra Naseem, Susan Synderburn, William Wallace, Neal Chaisson, Daniel A Culver
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引用次数: 0
Abstract
Positive pressure ventilation (PPV), both non-invasive and invasive, enhances ventilation but can sometimes lead to unexpected hypoxemia. This case report describes an instance of paradoxical hypoxemia after initiating bilevel positive airway pressure (BiPAP) in a 58-year-old female with a medical history of systemic lupus erythematosus, interstitial lung disease, and pulmonary embolism. BiPAP was started, leading to improved hypercarbia but worsened hypoxemia. Further investigation revealed a right-to-left interatrial shunt via a small patent foramen ovale (PFO). Adjusting BiPAP settings improved arterial blood gas parameters. This case illustrates how positive pressure ventilation with underlying PFO can cause paradoxical hypoxemia. The case emphasizes the importance of understanding the pathophysiology and tailoring BiPAP settings based on individual haemodynamics.
Learning points: Positive pressure ventilation can trigger paradoxical hypoxemia through a right-to-left shunt in patients with patent foramen ovale.Unexplained hypoxemia after initiating positive pressure ventilation warrants investigating intracardiac shunts with a saline contrast echocardiogram.Adjusting bilevel positive airway pressure settings based on individual haemodynamics is essential for improving oxygenation.
期刊介绍：
The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from 33 European countries. The Journal''s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field. EJCRIM welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight and/or contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors). The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.
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