Fluid resuscitation in a patient with severe hypovolemic shock and severe pulmonary capil-lary leak
- VernacularTitle:重度肺毛细血管渗漏并发严重低血容量性休克的液体复苏：附1例报告
- Author:
Haiting XIE
1
;
Zhongli LI
;
Duobin WU
;
Ping CHANG
;
Zhanguo LIU
Author Information
1. 南方医科大学珠江医院重症医学科
- Keywords:
capillary leak;
hypovolemic shock;
controlled fluid infusion
- From:
Journal of Southern Medical University
2014;(1):137-140
- CountryChina
- Language:Chinese
-
Abstract:
A male patient undergoing extracorporeal ultrasound lithotripsy developed the symptoms of dyspnea, low blood pressure, palpitations, chest tightness, and sweating, and a clinical diagnosis of pulmonary capillary leak and hypovolemic shock was made. Pulse indicator continuous cardiac output (PiCCO) technique was used for resuscitation according to the measurements of extravascular lung water index (EVLWI) and global end-diastolic volume index (GEDI). The patient showed low levels of cardiac output (CO) and GEDI with a peak EVLWI of 32 ml/kg and profuse pink and thin sputum overflow from the trachea. The high ventilator support parameters failed to correct low oxygen saturation. Restricted fluid infusion was used to reduce pulmonary edema. Colloidal solution was given when GEDI was below 500 ml/m2, and the volume and fluid infusion rate were reduced for a GEDI higher than 500 ml/m2. Pulmonary edema was gradually reduced after the treatments with improvement of lactic acid level and liver and kidney functions. Vasopressors were withdrawn 6 days later, mechanical ventilation was discontinued 10 days later, and tracheal intubation was removed 25 days later, after which the patient was discharged. In the treatment of the patient, PiCCO monitoring played an important role.
