Abstract
A 66-years-old male ICU-ID No-82050318, who was previously healthy, was suffered from severe respiratory distress after cholecystectomy with preoperative diagnosis of gallbladder cancer. Although 4, 000ml of whole blood transfusion was given during the first operation, continuous bleeding from the abdominal drainage was not controlled post-operatively. Reoperation was performed at about 24hours later.
At the time of admission to ICU, PaO2 was 74.1mmHg, and PaCO2 was 36.8mmHg under the mechanical ventilation with FIO2 1.0. His pulmonary arterial pressure was 32/14mmHg, pulmonary capillary wedge pressure 14mmHg, cardiac index 4.3L/min · m2 and pulmonary vascular resistance 85 dyne sec/cm5.
DIC was denied because of supporting data of fibrinogen 265mg/dl, PT 54%, APTT 49.8sec and FDP 20μg/ml. His chest radiograph was normal. The diagnosis of ARDS was concluded and treated by mechanical ventilation with a step-like increase in PEEP level.
His respiratory parameters improved gradually by mechanical ventilation with PEEP level of 15 cmH2O, but weaning from the respirator was delayed until 13th ICU days, because of suspected intra -abdominal infection.
Pulmonary microvascular pressure was between 10 and 20 mmHg and plasma colloid osmotic pressure was near 20mmHg. His complement titer (CHSO, C 3) were low at 1 st ICU day and reactive elevation of complement at the following postoperative course was not so high as in the uncomplicated postoperative patients. Pathophysiology and therapy for ARDS was discussed.
