Case Report
Volume 6 Issue 10 - 2020
A Healthy 36-Year-Old Woman with Hypoxia, Hemoptysis and Pneumomediastinum Immediate Post Extubation after Lower Segment Cesarean Section
Mariam Ali Alansari*
Consultant Intensivist, Department of Internal Medicine, Al Imam Abdulrahman Bin Faisal Hospital, Ministry of National Guard Health Affairs, Dammam, Kingdom of Saudi Arabia
*Corresponding Author: Mariam Ali Alansari, Consultant Intensivist, Department of Internal Medicine, Al Imam Abdulrahman Bin Faisal Hospital, Ministry of National Guard Health Affairs, Dammam, Kingdom of Saudi Arabia.
Received: August 27, 2020; Published: October 31, 2020




Abstract

A 36-year-old female (Mallampati class I), with no previous medical history, was transferred to the Surgical Intensive Care Unit following uneventful lower segment Cesarean Section (which lasted three hours for placenta accrete). The operative course was notable for minimal blood loss. She was intubated and mechanically ventilated and the plane was to extubate in the Surgical Intensive Care Unit (SICU).

In the SICU, the patient had return of spontaneous breathing but was severely agitated with aggressive cough and strong inspiratory efforts. In addition, she was continuously biting the endotracheal tube. As she was responding to verbal commands and maintaining good oxygen saturation, she was planned for extubation. No medications were given then. Immediate post extubation, the patient developed sub sternal chest pain, tachypnea and tachycardia requiring 100% oxygen to maintain oxygen saturation above 92%. Her vital signs were otherwise normal. Bilateral rhonchi were audible during auscultation with a frothy serosanguinous fluid being suctioned from the oropharynx. Within 2 min, this fluid became progressively bloodier. The patient soon coughed up around 200 ml of bright-red blood followed by another one in 5 minutes. Anteroposterior chest radiograph was performed showed perihilar interstitial and alveolar opacification consistent with pulmonary edema/hemorrhage. Air bronchograms and peribronchial cuffing were noted too. A repeat hemoglobin showed a significant drop from preoperative level of 13 g.dl to 10 g.dl−1 postoperatively. High-resolution computed tomography (CT) sections displayed a striking preferential central and nondependent distribution of ground-glass attenuation (edema/hemorrhage) consistent with negative pressure pulmonary edema/hemorrhage.

As the patient was maintaining her airway as well as her blood pressure, noninvasive positive pressure ventilation with use of high supplemental O2 as well as diuretic were used. No bronchoscopy was performed, as the patient was not intubated and was clinically improving over the course of the first few hours with complete resolution of chest X-ray. The patient was discharged from the SICU in 48 hours. The rapid onset of symptoms, transient hemoptysis and rapid and complete resolution were all consistent with a diagnosis of negative pressure pulmonary hemorrhage.

Keywords: Postoperative; Extubation; Negative Pressure; Pulmonary Edema; Pulmonary Hemorrhage

Citation: Mariam Ali Alansari. “A Healthy 36-Year-Old Woman with Hypoxia, Hemoptysis and Pneumomediastinum Immediate Post Extubation after Lower Segment Cesarean Section”. EC Anaesthesia 6.11 (2020): 21-26.

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