Document Detail


Right-to-left interatrial shunt in ARDS: dramatic improvement in prone position.
MedLine Citation:
PMID:  10342518     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
A Legras; P F Dequin; E Hazouard; O Doucet; F Tranquart; D Perrotin
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Intensive care medicine     Volume:  25     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  1999 Apr 
Date Detail:
Created Date:  1999-08-05     Completed Date:  1999-08-05     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  412-4     Citation Subset:  IM    
Affiliation:
Service de Réanimation médicale, Hôpital Bretonneau, Tours, France.
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MeSH Terms
Descriptor/Qualifier:
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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