CHEST Guidelines-A-67-Year-Old-Man-With-Severe-Posttraumatic-ARDS-i

A-67-Year-Old-Man-With-Severe-Posttraumatic-ARDS-i

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A 67-year-old man with a history of myocardial ischemia and atrial fibrillation was initially discharged from a hospital after mild thoracic trauma. He was subsequently readmitted with severe dyspnea, diagnosed with acute respiratory distress syndrome (ARDS), and treated in the ICU with CPAP and then mechanical ventilation. Due to worsening gas exchanges, venovenous extracorporeal membrane oxygenation (ECMO) was initiated. Six days later, while still on ECMO but hemodynamically stable, the patient experienced sudden desaturation and thoracic asymmetry, prompting an investigation for pneumothorax using lung ultrasound.<br /><br />Lung ultrasound revealed no sliding in the left anterior field and identified a lung point at the midaxillary line, confirming the diagnosis of pneumothorax. Lung ultrasound (LUS) has become an important tool for assessing acute respiratory failure due to its high diagnostic accuracy for pneumothorax, outperforming chest radiographs but corroborating with CT scans, the latter limited by factors like cost and necessity for transport. LUS can swiftly identify pneumothorax via distinctive artifacts, such as the presence of lung sliding, lung pulse, or B-lines, all of which rule out pneumothorax.<br /><br />In this case, the ultrasound confirmed pneumothorax, and a chest drain was placed with ultrasound guidance, improving the patient's gas exchanges. Despite this intervention, the patient's condition deteriorated, and he succumbed to pulmonary fibrosis 50 days later. This case highlights LUS's efficacy as a noninvasive, bedside tool for diagnosing pneumothorax in critically ill patients, guiding effective interventions, and surpassing traditional imaging techniques in immediacy and safety.

Keywords

myocardial ischemia

atrial fibrillation

acute respiratory distress syndrome

ECMO

pneumothorax

lung ultrasound

mechanical ventilation

thoracic trauma

pulmonary fibrosis

diagnostic accuracy