Lung Collapse in Intubated Patient is not Always because of Tube Factor?
|Sanjay Singhal1*, Vivek Chopra2, Kiran S3 and Soubhadra Chakraborty4|
|1Pulmonary and Critical Care Specialist, Department of Medicine, Command Hospital (CC), Lucknow 226003, India|
|2Classified Specialist (Anaesthesiology), Department of Anaesthesiology & Critical Care, Command Hospital (EC), Kolkata 700027, India|
|3Classified Specialist (Anaesthesiology) & Trained in Critical Care, Department of Anaesthesiology & Critical Care, Command Hospital (EC), Kolkata 700027, India|
|4Post Graduate Resident (Anaesthesiology), Department of Anaesthesiology & Critical Care, Command Hospital (EC), Kolkata 700027, India|
|Corresponding Author :||Dr. Sanjay Singhal
Pulmonary and Critical Care Specialist
Command Hospital (Central Command)
Lucknow 226003, India
E-mail: [email protected]
|Received July 06, 2012; Accepted August 06, 2012; Published August 08, 2012|
|Citation: Singhal S, Chopra V, Kiran S, Chakraborty S (2012) Lung Collapse in Intubated Patient is not Always because of Tube Factor? J Clin Case Rep 2:181. doi:10.4172/2165-7920.1000181|
|Copyright: © 2012 Singhal S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
50 year old male, diagnosed case of Chronic Obstructive Pulmonary Disease (COPD) was admitted to ICU as a case of cellulitis of left lower limb with septic shock and multi-organ dysfunction. On admission, he was managed with intravenous fluids, vasopressor (noradrenaline), broad spectrum antibiotics, nebulisation and mechanical ventilation. Gradually, he showed improvement clinically as well as in laboratory parameters. On fourth day, he became haemodynamically stable, maintaining oxygen saturation on minimal ventilatory support (Pressure Support mode) and was planned for extubation on the next day. But, he developed respiratory distress (respiratory rate 35/minute, use of accessory muscle present) while on Pressure Support Ventilation along with hypoxemia. He was immediately placed on control mode of mechanical ventilation with tidal volume of 350 ml (6 mls/kg) which showed high airway pressures (PIP>40 cm H2O) with every inspiratory effort. Suctioning of the endotracheal tube was done with a 12 Fr Gauge suction catheter by open method which could be negotiated up to the carina with minimal secretions being aspirated with poor cough reflex. Chest auscultation revealed diminished air entry on left side. The position of the tube was re-confirmed with direct laryngoscopy.