Pulmonary. Edema after Pericardial. Drainage for Cardiac Tamponade*. Fred. Glasser. M.D.; ..... factors such as sepsis, gastric aspiration, pulmonary contusion and multiple .... articles can be downloaded for teaching purposes in PowerPoint.
Non-cardiogenic pulmonary edema after pericardial drainage for cardiac tamponade. F Glasser, A M Fein, S H Feinsilver, E Cotton and M S Niederman Chest 1988;94;869-870 DOI 10.1378/chest.94.4.869 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/94/4/869
Chest is the official journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright1988by the American College of Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder. (http://chestjournal.chestpubs.org/site/misc/reprints.xhtml) ISSN:0012-3692
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selectedreimrts NonCardiogenic Pulmonary Edema after Pericardial Drainage for Cardiac Tamponade*
,
,
Glasser
We
report
a
patient
syndrome
distress
ade. Because in this
situation, fluid
massive
developed
we with
fluid
recommend
shifts
ericardiocentesis
for
ponade
to a variety
may lead
perforation
of
arteries,
the
the
right
Recent
1
severe
pulmonary
one
patient,
nary
edema
cular
resulted with
persisted
capillary
sac. that
unit
was
respiratory
distress
knowledge ously.
this
cardiac
septal
with
procedure.2.3 that
the
In
No
he-
bloody
fluid.
blood
pressure
emergency
was room.
perAfter
Following
to the
the
increased operating
of unknown
edema,
which
silhouette
of the
mm
room
for a partial
pericardial
Hg and
the
effusion
the
patient
was
pericardiectomy.
An intra-
had
decreased
in
size
with
diffuse
bilateral
alveolar
infiltrates consistent with pulmonary edema. Initial arterial blood gas levels (F1o2= 1.0) were pH, 7.48; PaCo2, 36 mm Hg; Pa02, 62 mm Hg. He remained severely hypoxemic on a F1o2, 1.0 with bilateral infiltrates and normal microvasculature pressures for the next week (Table 1). The patient’s chest roentgenogram (Fig 2) gradually showed clearing and his hypoxemia slowly improved over two weeks at which time he was extubated. Cytologic and microbiologic studies of the pericardial fluid were unremarkable.
ml
obtained of the
in our alveolar
from
the
Our
patient
developed pericardial distress
developed following fluid, although the
of 2, 100
for
release
to 110/70
operatively placed Swan-Ganz catheter revealed pulmonary artery pressure of37/18 mm Hg and a pulmonary artery occlusion pressure of 12 mm Hg. Chest roentgenogram (Fig 1) revealed the cardiac
of a large respiratory
chest
roentgenogram
pulmonary
edema
during
effusion. The immediate suggests that the pulmonary withdrawal pulmonary were
drainage onset of edema
of 100 ml of pericardial artery catheterization and
performed
60
minutes
after
this
adult
in this
patient.
To our
been
reported
previ-
not
pericardiocentesis in the
of
DISCuSSION
patient.
responsible
has
volume
pulmo-
flooding.
drainage
seen
approach
microvas-
tamponade
part
complication
REPORT
with Down’s syndrome and a ventricular defect which had not previously limited his activity, presented dyspnea. Three months prior to admission he reported
symptoms
white
man
of an upper
respiratory
admission he developed with a 15 pound weight Physical with
this
Hemodynamic data increased permeability
CASE
A 33-year-old
and that
suggested
pulmonary
syndrome
coronary
have
alveolar
in
of
pneumothorax
for the second
following
at least
including
in pulmonary
severe
week
the pericardial patient indicated
elevation
with
tam-
pericardial
suggested
available
developed
for one
follow
subsequent
a patient
who
patients
data
data were
We describe
of
the dire
this
laceration
may
from
of peal-
to limit
of complications
of two
edema
pressure,
etiology
treatment
hemodynamic
modynamic
removal
hypotension,
reports
tamponade,
a subxiphoid
taken
tamponedema
to herald
ventricle,
arrhythmias,
respiratory
monitoring
which appear 1988; 94:869-70)
(Chest
complication.
gradual
hemodynamic
of suspected
formed
via
with an estimated
effusion
aspiration of 100 ml of fluid, the blood pressure fell to mm Hg and the patient developed markedly distended neck veins with respiratory distress and was intubated. An immediate left anterior thoracotomy was performed, draining 2,000 ml of
M.D.;
of pericardial ofpulmonary
recognition
pencardial
80/60
adult
relief
following
ofincreasing
cardial
P
who
in a large
1,500 ml. Because the
M.D.; Alan M. Fein, M.D. F,C.C.P; Steven H. Feinsilver, M.D. F.C.C.P; Elisabeth Cotton, and Michael S. Niederman, M.D. , F.C.C.!? Fred
swinging
examination
a pulsus
distant
with
remarkable
of
The neck a grade
3/6 systolic
for pitting
edema
blood
16
veins
infection;
dyspnea
revealed
paradoxus
24 per minute.
tract
progressive gain. mm
Hg
were
pressure and
legs.
week
100/60
Heart
murmur.
the
*Fmm Winthrop-
the
Department University
of Pulmonary Hospital,
and
sounds
and Health
of
were were showed
fields.
showed
Hg
rate
Extremities
with
echocardiogram
.
to
mm
Electrocardiogram
diffuse low voltage with electrical alterans. Chest revealed a markedly enlarged cardiac silhouette A two-dimensional
prior
associated
a respiratory
distended.
ejection ofthe
one
on exertion
roentgenogram
Critical Sciences
SUNY-Stony Brook, Mineola, New York. Reprint requests: Dr Fein, Department ofPulmonanj/Critical Winthrop-University Hospital, Mineola, NY 11501
clear heart
lung to be
Medicine, Center,
Care,
FIGURE
shows
1. Chest roentgenogram following partial pericardiectomy diffuse alveolar filling without pleural effusions. CHEST
I 94 I 4 I
Downloaded from chestjournal.chestpubs.org by guest on July 10, 2011 © 1988 American College of Chest Physicians
OCTOBER, 1988
869
Table
1-Hemodynamic
and
Arterial
Blood
100/60 100/50
Pre-discharge
100/60
Pericardiectomy
procedure.
initial
Hemodynamic
a pressure
too
permeability
prolonged diffuse
low
were
illness
case
of the adult has
case,
been
reported
capillary
by
occlusion
of
twice
et
pressures
al,2
In
increased the
the
tamponade
thereby
allowed
overloading
a sudden
increase
the left ventricle
resistance remained animal data which
impaired
to a greater
pencardial
tamponade,
high.
This
indicate
that
extent
and
contrast,
our patient demonstrated capillary occlusion pressure
monary
refractory
hypoxemia,
following
requiring
that
of
return,
systemic
elevated,
different
such
40
.31
76
hemodynamic
profile
adult
pulmonary
respiratory
distress
strated
The during
at which Such
initial
possibility.
and
thus
rupture and been demon-
distension
lends
missed
noted
support
catheter
have
increase microvas-
pulmonary
venous
artery may
mm Hg rarely
hypotension
has
ofneurogenic
in jugular
pulmonary
is only
ie vessel
rupture
pericardiocentesis
The later
of 100/60
pulmonary
injury,”
re-
substantially
where
vessel
this
pressure
not
is the sudden high
“blast
model
In
of ARDS
edema
explanation
increase
the
was
pressure
to extremely
in an animal
marked
thus
dis-
pulmonary
transfusions.6
pericardiocentesis led
occurred.
aspiration,
pulmonary
possible
pressure,
gastric
blood
In addition,
return
leakage,
is associated
and
his baseline
Another
cular
heart
edema
for the development the lowest blood
Hg
remains occlusion
congenital
emergency
mm
edema capillary
pulmonary
risk factor However,
following
occ’
minutes
I
62
1.0
pulmonary
as sepsis,
80/50
from
in
and with
1.0
underlying
multiple
recovery.
in venous
in his pul-
-
his pulmonary
despite
and
was
is of In
-
permeability
patient’s was
permeability
factors
reported by
function
and had prolonged mechanical ventilation
of this
Usually,
upon
vascular
a “mismatch” tamponade.
the
At no time
corded
release
in venous
characterizes
patient, the only was hypotension.
drain-
His
with
etiology
with risk contusion
that
pressures
no elevation
The
ease. one
In
pericardial
left ventricular permitting reliefofthe
preload
afterload,
only
hypothesis is supported right ventricular function
than
thereby
while
which
pressure.
consistent
Pa02
syndrome. uncertain.
pulmonary
age suggested that high pulmonary microvascular were responsible. The authors hypothesized
more
pressure
available.
following
and clinical
a pericardial
before.
measurements Vandyke
a
syndrome.
drainage
only
hemodynamic
reported
distress
the
end-expiratory
thus
edema,
developed
hypoxemia
positive
was
Hg,
if capillary
patient satisfying
following
an
of 12 mm
by refractory thereby
-
-
flooding
The
respiratory
edema
were
alveolar
infiltrates,
Pulmonary effusion
cause
37/18
15
pressure
increased.
characterized
alveolar
definition
to not
F1o2
-
12
demonstrated
occlusion
Artery
Pressure (mm Hg)
-
measurements
capillary
pulmonary
Pulmonary
Pressure (mm Hg)
100/60
Day7
Post. erzcardiocentesis
Occlusion
Pressure (mm Hg)
Before Pericardiocentesis Immediately Post-Partial
Pre- and
Pulmonary Capillary
Systemic
Time of Measurement
Gas Data
Blood
to
the
this
placed
was initial
60
pressure
changes. REFERENCES
1 Wong
B,
J,
Murphy
Chang
CH,
Am
J Cardiol
of pericardiocentesis.
2 Vandyke
WH Jr, Cure
J,
Chakko
edema after pericardiocentesis Med 1983; 309:595-96 3 Shenoy
MM,
edema
CS,
Gheorghiade
for cardiac
M, Gittin
Dhar
following
Hasseneon, Dunn 1979; 44:1110-14
for
M.
Sabado
cardiac
risk
Pulmonary
tamponade.
R, SinhaAK,
pericardiotomy
M. The
J
N EngI
M. Pulmonary
tamponade.
Chest
1984; 86:647-48 4 McHugh nary
TJ, Forrester
vascular
dynamic
JS, Adler
congestion
and
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radiologic
L, Zion D, Swan HJC. myocardial infarction:
acute
correlations.
Ann
Intern
Pulmohemo-
Med
1972;
76:
29-33 5 Ditchey acute
R, Engler cardiac
R, LeWinter
tamponade
6 Fein A. Wiener-Kronish
I FIGURE
2. Chest
alveolar
filling
870
roentgenogram
pattern.
shows
clearing
of the
previous
physiology
Clinics 7 Chen resulting
of the
cerebral
Circ
Res
J1 Niederman
adult
respiratory
1986; 2:429-53 HI, Sun SC, Chal from
M. The role ofthe
in dogs.
1981;
M, Matthay distress
CY. Pulmonary compression.
heart
right
in
48:701-10
syndrome.
MA. Crit
PathoCare
edema and hemorrhage J Physiol 1973; 224:
Am
223-29
Non-cardiogenic
Pulmonary
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Edema
(Glasser
at a!)
Non-cardiogenic pulmonary edema after pericardial drainage for cardiac tamponade. F Glasser, A M Fein, S H Feinsilver, E Cotton and M S Niederman Chest 1988;94; 869-870 DOI 10.1378/chest.94.4.869 This information is current as of July 10, 2011 Updated Information & Services Updated Information and services can be found at: http://chestjournal.chestpubs.org/content/94/4/869 Cited Bys This article has been cited by 2 HighWire-hosted articles: http://chestjournal.chestpubs.org/content/94/4/869#related-urls Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://www.chestpubs.org/site/misc/reprints.xhtml Reprints Information about ordering reprints can be found online: http://www.chestpubs.org/site/misc/reprints.xhtml Citation Alerts Receive free e-mail alerts when new articles cite this article. To sign up, select the "Services" link to the right of the online article. Images in PowerPoint format Figures that appear in CHEST articles can be downloaded for teaching purposes in PowerPoint slide format. See any online figure for directions.
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