正压通气后的反常低氧血症:探索病理生理学。

Q3 Medicine
European journal of case reports in internal medicine Pub Date : 2024-10-30 eCollection Date: 2024-01-01 DOI:10.12890/2024_004976
Xin Ya See, Zehra Naseem, Susan Synderburn, William Wallace, Neal Chaisson, Daniel A Culver
{"title":"正压通气后的反常低氧血症:探索病理生理学。","authors":"Xin Ya See, Zehra Naseem, Susan Synderburn, William Wallace, Neal Chaisson, Daniel A Culver","doi":"10.12890/2024_004976","DOIUrl":null,"url":null,"abstract":"<p><p>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.</p><p><strong>Learning points: </strong>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.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"11 11","pages":"004976"},"PeriodicalIF":0.0000,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542950/pdf/","citationCount":"0","resultStr":"{\"title\":\"Paradoxical Hypoxemia Following Positive Pressure Ventilation: Exploring the Pathophysiology.\",\"authors\":\"Xin Ya See, Zehra Naseem, Susan Synderburn, William Wallace, Neal Chaisson, Daniel A Culver\",\"doi\":\"10.12890/2024_004976\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>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.</p><p><strong>Learning points: </strong>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.</p>\",\"PeriodicalId\":11908,\"journal\":{\"name\":\"European journal of case reports in internal medicine\",\"volume\":\"11 11\",\"pages\":\"004976\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-10-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542950/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European journal of case reports in internal medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.12890/2024_004976\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European journal of case reports in internal medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.12890/2024_004976","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0

摘要

正压通气(PPV),无论是无创还是有创,都能增强通气功能,但有时也会导致意想不到的低氧血症。本病例报告描述了一名 58 岁女性在启动双水平气道正压(BiPAP)后出现的矛盾性低氧血症,该患者有系统性红斑狼疮、间质性肺病和肺栓塞病史。开始使用 BiPAP 后,高碳酸血症有所改善,但低氧血症恶化。进一步检查发现,患者通过一个小的卵圆孔(PFO)出现了右至左心房间分流。调整 BiPAP 设置后,动脉血气参数得到改善。本病例说明了正压通气与潜在的 PFO 如何导致矛盾性低氧血症。本病例强调了了解病理生理学并根据个体血流动力学调整 BiPAP 设置的重要性:正压通气可通过卵圆孔未闭患者的右向左分流引发矛盾性低氧血症。启动正压通气后出现不明原因的低氧血症,需要通过生理盐水对比超声心动图检查心内分流。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Paradoxical Hypoxemia Following Positive Pressure Ventilation: Exploring the Pathophysiology.

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.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
2.10
自引率
0.00%
发文量
166
审稿时长
8 weeks
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.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信