An Application to Keep in Mind in Cases of Pulmonary Thromboembolism: Positive Airway Pressure System

Year 2022, , 82 - 84, 30.09.2022

Oğulcan Kınık , Kadir Yenal , Ahmet Emre Ay , Ahmet Burak Erdem , Safa Dönmez , Faruk Büyük

https://doi.org/10.33706/jemcr.1068447

Abstract

Massive pulmonary embolism is a vital emergency pulmonary pathology. Early diagnosis and treatment approach reduce mortality. Thrombolytic applications play an important role in the treatment. However, complications of thrombolytic therapy put a serious strain on physicians. In this case series, we aimed to present the management of carbon dioxide retention with the EzPAP® device in two young massive embolism patients who were given thrombolytic therapy.

Our 26 and 36-year-old male patients applied to our emergency department with complaints of flank pain and syncope, respectively. Massive PTE was detected in PCTAs taken due to hypoxia and tachycardia in our patients. When carbon dioxide retention developed in patients who were decided to be given thrombolytic therapy, barotrauma, which could be caused by non-invasive mechanical ventilation, was withdrawn. And it was decided to apply EzPAP® to these patients. In both patients, hypoxia and carbon dioxide retention were treated in a short time without complications. Etiological investigations of the patients are continuing and they were discharged with convalescence.

Conclusion; While thrombolytic therapy provides rapid and positive results, it also includes serious life-threatening side effects such as bleeding. EzPAP® can be used as an alternative treatment method for thrombolytic-related bleeding that may develop in the face and respiratory tract due to barotrauma of non-invasive mechanical ventilation.

Keywords

EzPAP®, Carbon dioxide retention, Massive pulmonary thromboembolism, Thrombolytic therapy

Supporting Institution

None

Project Number

None

Thanks

None

Pulmoner Tromboemboli Vakalarında Akılda Bulundurulması Gereken Bir Uygulama: Positive Airway Pressure System

Abstract

Masif pulmoner emboli hayati öneme sahip acil bir pulmoner patolojidir. Erken tanı ve tedavi yaklaşımı mortaliteyi azaltmaktadır. Tedavide trombolitik uygulamalar önemli bir yer almaktadır. Ancak trombolitik tedavi komplikasyonları hekimleri ciddi anlamda zorlamaktadır. Bu olgu serisinde trombolitik tedavi verdiğimiz iki genç masif emboli hastasında gelişen karbondioksit retansiyonunu EzPAP cihazı ile yönetimimizi sunmayı amaçladık.
26 ve 36 yaşında erkek hastalarımız sırasıyla yan ağrısı ve senkop şikayeti ile acilimize başvurdu. Hastalarımızda hipoksi ve taşikardi olması üzerine çekilen PBTA’larında masif PTE tespit edildi. Trombolitik tedavi verilmesine karar verilen hastalarda karbondioksit retansiyonu gelişmesi üzerine non-invazif mekanik ventilasyonun oluşturabileceği barotravmadan çekinildi. Ve bu hastalara EzPAP uygulanmasına karar verildi. Her iki hastada da kısa sürede hipoksi ve karbondioksit retansiyonuna komplikasyonsuz müdahale edildi. Hastaların etyolojik araştırmaları devam etmekte olup nekahatle taburcu edildiler.
Sonuç olarak; trombolitik tedavi hızlı ve olumlu sonuçlar sağlarken aynı zamanda kanama gibi ciddi hayatı tehdit edebilen yan etkiler içermektedir. Non- invazif mekanik ventilasyonun barotravmasına bağlı yüz ve solunum yollarında gelişebilecek trombolitiğe bağlı kanamalara karşı alternatif tedavi yöntemi olarak EzPAP kullanılabilir.

Keywords

EzPAP®, Karbondioksit retansiyonu, Masif pulmoner tromboemboli, Trombolitik tedavi

Project Number

None

References

• Sandler DA, Martin JF. Autopsy proven pulmonary embolism in hospital patients: Are we detecting enough deep vein thrombosis? J R Soc Med 1989; 82: 203-5.
• Wittram C, Maher MM, Yoo AJ, et al. CT angiography of pulmonary embolism: Diagnostic criteria and causes of misdiagnosis. Radiographics 2004; 24: 1219-38.
• Pulmonary thromboembolism diagnosis and treatment consensus report – 2015; 49-52. Turkish Thoracic Society.
• Omar A, Main E, Rand S. EZPAP®: The effects of increasıng gas flow and the alteration of breathing pattern on airway pressures, flows and volüme. WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS833–eS1237.
• Talley HC, Twiss K, Wilkinson S, et al. EZ - PAP in the Postoperative Period: A Pilot Study. Journal of Anesthesia & Clinical Research 2012, 3:8. doi: 10.4172/2155-6148.1000236.
• Goldhaber SZ. Pulmonary embolism. Lancet 2004; 363:1295-1305.
• Rieg AD, Stoppe C, Rossaint R, Coburn M, Hein M, Schälte G. EzPAP® therapy of postoperative hypoxemia in the recovery room. Experiences with the new compact system of end-expiratory positive airway pressure. Anaesthesist 2012; 61: 867–74.
• Elliott S. A retrospective analysis of the use of EZPAP positive pressure device by respiratory physiotherapists. Journal of ACPRC 2013; 45: 4-14.
• Talley HC, Twiss K, Wilkinson S, Buiocchi E, Lourens G, Motz J, Bueche R, et al. EZ - PAP in the Postoperative Period: A Pilot Study. Journal of Anesthesia & Clinical Research 2012; 3(8): 1000236.