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Peer Reviewed

What's Your Diagnosis?

​​​​​​​Breathless After Cardiopulmonary Resuscitation: How Would You Diagnose This Patient’s Respiratory Pattern?

Volume 61 - Issue 6 - June 2021

  • AUTHORS:
    Bilal Chaudhry, MD • Andrew Malek, MD • Kirill Alekseyev, MD, MBA

    AFFILIATIONS:
    ChristianaCare Health System, Christiana, Delaware

    CITATION:
    Chaudhry B, Malek A, Alekseyev K. Breathless after cardiopulmonary resuscitation: how would you diagnose this patient’s respiratory pattern? Consultant. 2021;61(6):e11-e12. doi:10.25270/con.2021.01.00003

    Received August 5, 2020. Accepted November 18, 2020. Published online December 29, 2020.

    DISCLOSURES:
    The authors report no relevant financial relationships.

    CORRESPONDENCE:
    Andrew Malek, ChristianaCare Health System, 4755 Ogletown Stanton Rd, Newark, DE, 19709 (andrewmalek273@hotmail.com)

     

    A 71-year-old woman with a history of chronic obstructive pulmonary disease (COPD), coronary artery disease, hypertension, and diabetes presented with dyspnea and septic shock. Volume resuscitation and antibiotics were given; however, she went on to develop progressive hypoxemia and went into cardiac arrest with pulseless electrical activity. Cardiopulmonary resuscitation (CPR) was initiated, with a total duration of 10 minutes before the return of spontaneous circulation. She was put on a ventilator and underwent extensive imaging studies; computed tomography scans showed pneumonia along with rib fractures. There was no evidence of pulmonary embolism.

    Her condition gradually improved, and she was weaned from the ventilator. The patient self-extubated prior to a trial of spontaneous breathing through a T-piece. Shortly thereafter, she began to develop respiratory failure requiring bilevel positive-airway pressure (BiPAP). Every time she was taken off of BiPAP, she developed severe respiratory distress. The respiratory pattern shown in the accompanying Video was seen.

     

     


    The video shows a patient who went into respiratory failure requiring bilevel positive-airway pressure (BiPAP). Every time she was taken off of BiPAP, she developed severe respiratory distress with the pattern shown here.