Breathless After Cardiopulmonary Resuscitation: How Would You Diagnose This Patient’s Respiratory Pattern?
Bilal Chaudhry, MD • Andrew Malek, MD • Kirill Alekseyev, MD, MBA
ChristianaCare Health System, Christiana, Delaware
Chaudhry B, Malek A, Alekseyev K. Breathless after cardiopulmonary resuscitation: how would you diagnose this patient’s respiratory pattern? Consultant. 2021;61(6):e11-e12. doi:10.25270/con.2021.01.00003
Received August 5, 2020. Accepted November 18, 2020. Published online December 29, 2020.
The authors report no relevant financial relationships.
Andrew Malek, ChristianaCare Health System, 4755 Ogletown Stanton Rd, Newark, DE, 19709 (firstname.lastname@example.org)
A 71-year-old woman with a history of chronic obstructive pulmonary disease (COPD), coronary artery disease, hypertension, and diabetes presented with dyspnea and septic shock. Volume resuscitation and antibiotics were given; however, she went on to develop progressive hypoxemia and went into cardiac arrest with pulseless electrical activity. Cardiopulmonary resuscitation (CPR) was initiated, with a total duration of 10 minutes before the return of spontaneous circulation. She was put on a ventilator and underwent extensive imaging studies; computed tomography scans showed pneumonia along with rib fractures. There was no evidence of pulmonary embolism.
Her condition gradually improved, and she was weaned from the ventilator. The patient self-extubated prior to a trial of spontaneous breathing through a T-piece. Shortly thereafter, she began to develop respiratory failure requiring bilevel positive-airway pressure (BiPAP). Every time she was taken off of BiPAP, she developed severe respiratory distress. The respiratory pattern shown in the accompanying Video was seen.
The video shows a patient who went into respiratory failure requiring bilevel positive-airway pressure (BiPAP). Every time she was taken off of BiPAP, she developed severe respiratory distress with the pattern shown here.