The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

NON-INVASIVE PRESSURE CONTROL AVOIDS INTUBATION IN PATIENT WITH AMNIOTIC EMBOLISM.

Felix Khusid1, Emma Fisher1, Bashar Fahoum1



Introduction: This is a presentation of a 26-year-old African American female that underwent an emergency cesarean section and was admitted to the ICU with a non-cardiogenic pulmonary edema as a result of an Amniotic Embolism. The patient's respiratory status significantly improved after placement on to a Servo I ventilator in a Non-Invasive PC mode.

Case Description:
A 26-year-old female, 32 weeks pregnant, presented with a ruptured membrane and an abnormality in fetal rate and rhythm. A low cervical emergency c-section was performed. The patient developed severe hypoxemia and became very tachypneic and tachycardic. A chest X-ray showed bilateral pulmonary infiltrates. An emergency echocardiogram was performed and showed normal left ventricular function. Within 30 minutes of the C-Section the patient developed a non-cardiogenic pulmonary edema as a result of the Amniotic Embolism. Pt was placed on a Non-Rebreathing mask. O2Sat of 66%, RR-60, HR-150 was observed. An ABG revealed
PH-7.35, PaCO2-28, PaO2-41, HCO3-17, O2 Sat-76%.
The patient was placed on Servo I ventilator in non-invasive PS mode, PS+6, PEEP+5, FiO2-90%.
Within 5 minutes the patient's O2Sat increased to 100% however RR only decreased to 52/min. The patient was placed on Non-Invasive PC with PC+6cmH2O, RR-12, PEEP+5,FiO2-90%.
The patient's level of dyspnea significantly decreased, RR stabilized at 24/minute.
An ABG within 30 minutes revealed the following; PH-7.39, PaCO2-41, PaO2-121, O2 Sat 99%.
Within 8 hours the patient was successfully converted to Bi-PAP Vision with a nasal pillows.
FiO2 titrated down to 35% on Bi-PAP within 24 hours.
On day 3 of hospitalization the patient was switched to a N/C of 4L/min. O2 Sat of 96% to 98% was maintained. A chest X-Ray revealed complete resolution of the pulmonary infiltrates. On day 5 she was successfully discharged home.

Discussion:
Despite the placement of the patient on a Non-Rebreathing mask, she remained severely hypoxic and tachypneic. The placement of the patient on Non-Invasive PC proved to be decisive in avoiding an intubation.

Conclusion:
Utilization of Non-Invasive PC as well as Non-Invasive PS could be beneficial in decreasing ventilation-perfusion mismatch and improving oxygenation even in non-traditional applications such as in the supportive treatment for Amneotic Embolisms reducing the need for intubation.