A 37-Year-Old Woman With Diabetes Mellitus, Systemic Hypertension, and Chronic Kidney Disease Admitted With Multifocal Pneumonia and Empyema

作者:Huggins J Terrill*; Karakala Nithin; Campbell Ruth; Kummerfeldt Carlos; Nestor Jennings; Pastis Nicholas J; Doelken Peter
来源:Chest, 2014, 146(2): E41-E46.
DOI:10.1378/chest.13-2711

摘要

A 37-year-old woman with a medical history of type 1 diabetes mellitus, systemic hypertension, and chronic kidney disease due to glomerulosclerosis was admitted with multifocal pneumonia and empyema. She underwent a small-bore tube thoracostomy placement and rapidly developed respiratory failure and shock. She was intubated and started on norepinephrine. Table 1 is a summary of the daily urine output (UOP), fluid balance per day, and corresponding serum creatinine level during the initial ICU stay. Mechanical ventilator settings were as follow: pressure-regulated volume control; tidal volume, 450 mL; respiratory rate, 20 breaths/min; positive end-expiratory pressure (PEEP), 8 cm H2O; and FIo(2), 50%. Urinary sediment was positive with granular casts. The calculated plateau pressure (PP) was 32 cm H2O. On day 4, consultation requested a point-of-care echocardiography (POCE) to be performed. Video 1A shows the subcostal longitudinal view of the inferior vena cava (IVC), and Figure 1 shows the corresponding M mode of the IVC. Figure 2 shows an apical 5C view of the pulse-wave Doppler of the left ventricular (LV) outflow tract (LVOT) and Video 1B, an apical 4C view. Video 1C shows the lung ultrasound (abnormal lung finding seen diffusely). Pulse-wave Doppler of the mitral infl ow showed an impaired relaxation pattern with E to A wave reversal. Calculated E/e%26apos; was %26lt;8 (not shown).

  • 出版日期2014-8

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