Description
- Abstract:
- Introduction: Prone-positioning has been associated with improvements in patient oxygenation and reduction of ventilator-induced lung injury. Recent data suggests that early use of prone positioning in patients with ARDS improves mortality. We present the case of a 39 year-old male who developed ARDS secondary to TRALI. The patient was successfully treated with prone positioning over the span of three days. Case report: A 39 year-old male with a history of cholangiocarcinoma complicated by biliary stricture for which he underwent stenting was admitted the intensive care unit for septic shock from cholangitis. He was supported with fluids, antibiotics and vasopressors and evaluated by interventional radiology which offered to provide source control with a percutaneous biliary drain. The patient had a developed a mild coagulopathy with an INR 1.7 so at the request of interventional radiology the patient was transfused with three units of fresh frozen plasma prior to the procedure. Immediately post procedure, the patient became more hypotensive and developed new and profound hypoxia. A chest x-ray revealed the development of new and extensive airspace disease bilaterally and he required intubation. A diagnosis of TRALI was made, supported by a marked drop in white blood cell count, a normal echocardiogram and the timing of the decompensation. He was started on a low tidal volume ventilation strategy, yet was only able to obtain a PO2 of 62 mmHg and oxygen saturation on 100% Fio2 with a PEEP of 18, so the decision to prone the patient was made. He was proned within 16 hours of his development of TRALI and showed immediate improvements in oxygenation and saturation. He received two 16 hour proning sessions over the next 2 days and continued to improve. After day 3 of admission, the patient was able to spontaneously breathe and was extubated. He remained hemodynamically stable and discharged home by day 13. Discussion: Multiple studies have shown that proning leads to improved oxygenation due to a number of mechanisms, including improved recruitment, V/Q mismatch and decreased lung compression by adjacent tissues. A recent study now suggests a mortality benefit with the early use of prone ventilation in ARDS patients. Our patient with TRALI and ARDS quickly recovered after he was ventilated in the prone position. Prompt diagnosis of ARDS and a low threshold for the use of prone positioning may improve patient outcome in the intensive care unit.
- Notes:
- Scholarly concentration: Advocacy and Activism
- Presented at: American Thoracic Society, May 2014
- Peer-reviewed
Citation
Hussain, Rashid, Saraiya, Ami, Giaccotto, Joshua, et al.,
"Early prone positioning to treat transfusion-related acute lung injury (TRALI)"
(2010).
Warren Alpert Medical School of Brown University Scholarly Concentrations Program Gallery of Scholarly Work.
Brown Digital Repository. Brown University Library.
https://repository.library.brown.edu/studio/item/bdr:659451/
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Warren Alpert Medical School of Brown University Scholarly Concentrations Program Gallery of Scholarly Work
The Scholarly Concentrations Program is an elective program through which Warren Alpert Medical School students may elect to pursue a course of study beyond that of the conventional medical education curriculum....