Abstract
Five hours following an uneventful coronary artery bypass graft operation, an otherwise healthy 54-yr-old man developed a pneumothorax while his lungs were being ventilated in the recovery room. Neither arterial blood gas analysis, ventilatory variables, nor clinical examination had suggested this diagnosis, which was made subsequent to a chest radiograph taken as part of the assessment of hypotension. At the same time, the waveform of the pressure tracing from his pulmonary artery catheter changed inexplicably while attempting balloon inflation as part of the assessment of the hypotensive episode. In retrospect, the changes in the pressure tracing most likely were due to alterations in the pulmonary vasculature associated with the pneumothorax. These changes can be explained in terms of a well-known physiological model. If such changes are encountered in similar circumstances, a tension pneumothorax should be suspected.
Résumé
Un homme de 54 ans, sous ventilation mecanique, developpa un pneumothorax cinq heures après une revascularisation coronarienne. Le diagnostic que ni les gaz artériels, ni les variables respiratoires, ni l’examen clinique n’avaient laissé suspecter fut établi à I’aide d’une radiographie pulmonaire faite lors d’un épisode d’hypotension. Le trace des pressions transmises par le cathéter de l’artère pulmonaire se comportait alors de façon inhabituelle lorsqu’on en gonflait le ballon, à la recherche de la cause de cette hypotension. En retrospective, ce tracé particulier était probablement relié aux effets du pneumothorax sur les vaisseaux pulmonaires que l’on peut d’ailleurs expliquer à partir d’un modéle physiologique connu. Il faut done être à l’affût d’un pneumothorax si l’on rencontre un tracé semblable en des circonstances similaires.
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Yu, P.Y.H., Lee, L.W. Pulmonary artery pressures with tension pneumothorax. Can J Anaesth 37, 584–586 (1990). https://doi.org/10.1007/BF03006331
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DOI: https://doi.org/10.1007/BF03006331