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International Journal of Advances In Case Reports

Volume 11, Issue 1, 2024
Mcmed International
International Journal of Advances In Case Reports
Issn
XXX-XXXX (Print), 2349 - 8005 (Online)
Frequency
bi-annual
Email
editorijacr@mcmed.us
Journal Home page
http://mcmed.us/about/ijacr
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Abstract
Title
37 YEARS OLD MAN WITH SEVERE RESPIRATORY FAILURE POST-OPERATIVE OPEN ABDOMINAL AORTIC ANEURYSM REPAIR: LESSONS TO LEARN
Author
Mariam A. Alansari and Mohammad F Azfar,
Email
icu_mariam@yahoo.com
keyword
Open triple AAA repair, Complications, Fluid managements, Ischemic Preconditioning.
Abstract
37 years old male, smoker underwent open aortic aneurysm repair with 10 hours of aortic clamping time, not reported previously. In the operative room, the patient required 10 units of blood. Post operatively, right leg faschiotomy was required. Ten hours post faschiotomy, he was extubated. In view of raising urea and creatinin and the fear of patient developing acute renal failure secondary to acute tubular necrosis and rhabdomiolysis secondary to prolonged aortic clamping time, the vascular surgeon had asked to over hydrate the patient (target CVP 16 cm H2O) with a maintenance IV fluids of 300 ml/hr. Seventy two hours post triple AAA repair, the patient went into respiratory failure requiring reintubation. Chest X-ray showed bilateral upper and lower zones infiltrates. He was afebrile with normal white cell count, ECG, cardiac enzymes, brain natriuretic peptide and procalcitonin. He was diagnosed to have Adult Respiratory Distress Syndrome secondary to ischemic reperfusion injury requiring reintubation and mechanical ventilation. He remained in the ICU for three weeks before being discharged alive. We think factors like positive fluid balance, lack of remote ischemic preconditioning as well as not practicing intraoperative auto-transfusion contributed to the complicated course of this patients. We therefore wanted to share this case with our colleagues.
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