RESUMO
An elderly male presented for emergent repair of a ruptured abdominal aortic aneurysm. For anticipated volume resuscitation, vasopressor administration, and hemodynamic monitoring, a large-bore central venous catheter was placed in the left internal jugular vein under ultrasound guidance before surgical incision. Initially, there were no readily apparent signs of venous perforation. However, a massive left hemothorax developed because of perforation of the brachiocephalic vein and violation of the pleural space. This case report discusses both prevention and management of such a complication.
Assuntos
Veias Braquiocefálicas/lesões , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres Venosos Centrais , Hemotórax/etiologia , Veias Jugulares , Lesões do Sistema Vascular/etiologia , Idoso de 80 Anos ou mais , Veias Braquiocefálicas/diagnóstico por imagem , Hemotórax/diagnóstico por imagem , Hemotórax/terapia , Humanos , Veias Jugulares/diagnóstico por imagem , Masculino , Flebografia , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/terapiaRESUMO
BACKGROUND: Patients undergoing abdominal wall reconstruction are at risk of developing major postoperative respiratory complications. The authors attempted to identify factors predictive of respiratory complications following abdominal wall reconstruction. METHODS: All patients who underwent complex abdominal wall reconstruction over a 2-year period were reviewed. The primary endpoint studied was severe respiratory complication, defined as respiratory insufficiency requiring intubation or transfer to a higher level of care. RESULTS: Sixty patients underwent complex abdominal wall reconstruction during the study period. The incidence of respiratory complications was 20 percent. Factors predictive of postoperative respiratory complication included age (p = 0.05), American Society of Anesthesiologists score (p = 0.04), and hernia defect size (p = 0.01). In addition, patients who developed respiratory complications were more likely to have had a greater change in plateau pressure (5.8 versus 2.3 cmH(2)O; p = 0.01). The greater the change in plateau pressure, the greater the risk of developing a respiratory complication: for a change in plateau pressure greater than or equal to 6 cmH(2)O, the odds ratio was 8.67; for a change in plateau pressure greater than or equal to 9 cmH(2)O, the odds ratio was 11.5. CONCLUSIONS: Respiratory complications following abdominal wall reconstruction can be serious and are associated with prolonged hospitalizations. Patients with an increase in their plateau pressure of greater than 6 cmH(2)O are at an increased risk of severe postoperative respiratory complications.
