Pregledni rad
https://doi.org/10.26800/LV-144-supl3-10
Challenges of volume resuscitation in polytraumatized patient following massive transfusion protocol and prolonged mechanical ventilation
David Dedić
; Klinika za anesteziologiju, reanimatologiju i intenzivnu medicinu, Klinička bolnica Dubrava, Zagreb
Sonja Hleb
; Klinika za anesteziologiju, reanimatologiju i intenzivnu medicinu, Klinička bolnica Dubrava, Zagreb
Davorka Židak
; Klinika za anesteziologiju, reanimatologiju i intenzivnu medicinu, Klinička bolnica Dubrava, Zagreb
Jasminka Peršec
; Klinika za anesteziologiju, reanimatologiju i intenzivnu medicinu, Klinička bolnica Dubrava, Zagreb
Prilozi: 00d_SADRZAJ.pdf
Sažetak
Case report of a 58-year-old polytraumatized patient, without known prior comorbidities, injured during a fall from a 12 meter height, while sustaining multiple life-threatening injuries. She underwent 5 subsequent serious surgical interventions, followed by special dedication to volume management and prolonged mechanical ventilation. Initially, her injuries led to severe blood loss and onset of haemorrhagic shock, which was temporarily obscured by her compensation mechanisms. On admission the patient had invasive monitoring and temporarily required continuous vasoactive support (norepinephrine and vasopressin). She also required immediate surgical intervention and resuscitation through massive transfusion protocol. On the 10th day of hospitalization, she once again required surgery due to active spleen haemorrhage, after which the need for blood derivates was drastically reduced. Her recovery is further complicated with development of ARDS due to trauma of the thorax and hospital acquired pneumonia, accompanied by bilateral pleural effusions. Detailed cardiac examinations discovered cardiac background to the problem and a mitral valve replacement was mandatory. Postprocedural period was characterized by acute renal failure as a combination of elements which include organ trauma, treatment with nephrotoxic antibiotics, along with independent risks applied to cardiopulmonary bypass during cardiac surgery. After two cycles of continuous haemodiafiltration, renal function shows progressive improvement and recovery. Another challenge in patient´s recovery was her respiratory status and dependence on mechanical ventilation. Despite being admitted with bilateral multiple rib fractures and lung contusions, she was successfully
ventilated with minimal pressure support and lower PEEP values for the vast majority of time. After 60 days of mechanical ventilation, spontaneous breathing is successfully established. Despite several life-threatening injuries and numerous following complications, the patient was successfully treated over the course of 95 days in the Intensive Care Unit.
Ključne riječi
POLYTRAUMA; VOLUME MANAGEMENT; MASSIVE TRANSFUSION; MECHANICAL VENTILATION
Hrčak ID:
284189
URI
Datum izdavanja:
25.9.2022.
Posjeta: 688 *