| Right-to-left interatrial shunt in ARDS: dramatic improvement in prone position. | |
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MedLine Citation:
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PMID: 10342518 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The mechanisms leading to shunting through a patent foramen ovale include high right-sided cardiac pressures and respiratory factors due to mechanical ventilation and also anatomical changes in the right atrium as described in the platypnea-orthodeoxia syndrome. We report a patient with the adult respiratory distress syndrome (ARDS) who had a right-to-left atrial shunt which decreased in the prone position, after which oxygenation improved. The patient was admitted to the intensive care unit because of ARDS due to an invasive fungal infection. He had a history of chronic lymphocytic leukemia and paradoxical embolisms through a patent foramen ovale. Despite mechanical ventilation and antifungal treatment he developed severe ARDS. He was therefore turned to the prone position. Blood gas values improved dramatically (arterial oxygen tension/fractional inspired oxygen ratio increasing from 59 to 278 torr). Transcranial Doppler sonography was performed with bubble study, which confirmed a massive right-to-left shunt in the supine position and which instantaneously decreased in the prone position. This case suggests that a decrease in right-to-left shunt in patients who have a patent foramen ovale could partly explain the improvement in hypoxemia in the prone position. |
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Authors:
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A Legras; P F Dequin; E Hazouard; O Doucet; F Tranquart; D Perrotin |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Intensive care medicine Volume: 25 ISSN: 0342-4642 ISO Abbreviation: Intensive Care Med Publication Date: 1999 Apr |
Date Detail:
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Created Date: 1999-08-05 Completed Date: 1999-08-05 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 412-4 Citation Subset: IM |
Affiliation:
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Service de Réanimation médicale, Hôpital Bretonneau, Tours, France. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Anoxia / physiopathology* Cerebral Arterial Diseases / physiopathology*, ultrasonography Fatal Outcome Heart Septal Defects, Atrial / complications Humans Leukemia, Lymphocytic, Chronic, B-Cell / complications Male Prone Position* Respiration, Artificial* Respiratory Distress Syndrome, Adult / complications, therapy* Ultrasonography, Doppler, Transcranial |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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