Acute Lung Injury

Case
 P.S.
     20 year old male Unrestrained MVC with + LOC Obvious left femur fx Left SDH T4 & T6 fx

Case
 ER (4/5/10)
 Vitals:
 BP: 142/83  Pulse: 105  RR: 15  02 SAT: 100  GCS: 3T  WT: 68 KG

Case
 ER
 Labs:

 + Benzo  ETOH 229

Case
 ER
 Medications:
 Propofol gtt 10mcg/kg/min IV  Fentanyl gtt 1 mcg/kg/min IV  Vecuronium 10 mg IVP  Protect study drug 14.3 ml/hr IV  Fosphenytoin 1 gm IV

Case
 ER
    Intubated CT head: Left SDH CT chest: Bilateral pulmonary contusions Medications:

Case
 SICU (4/6/10)
 Medications:
 Phenytoin Maintenance dose of 125 q8 hrs IV  Propofol gtt 15 mcg/kg/hr IV (to MAAS of 3)  Fentanyl gtt 1 mcg/kg/hr  Albuterol 2.5 mg neb q4  Atrovent 0.5 mg neb q4  Nexium 40 mg daily IV  Protect study drug 10 ml/hr IV

Case
 Medications
 Aztreonam 1 gm q8 IV(4/11-4/13) IV(4/11 Vancomycin 1 gm q12 IV (4/11)  Tobramycin 500 mg qday IV (4/11-4/13) (4/11-

Case
 SICU
 4/6      4/7   4/8    4/9  SCDs for DVT px C-spine clear Repeat CT head negative Vent mode simv OR for femur fx repair 5% albumin 500 ml IV X1 Dobhoff placed- advance impact to goal (80 ml/hr) placed-

Desated to 80s, HR >150, hypertensive, aggressive pulmonary toiletng and manual ambued.  Rotorest bed  Vecuronicum gtt started (Secondary to poor pulmonlary status)  2 units PRBCS  NO 20 ppm  Vent mode: Bilevel  Bilateral fluffy infiltrates on chest xray

Case
 4/10  Tmax 38.8 C (Cultures pending)  Empiric Vanc, aztreonam, tobra  HR 120-130 120 Chest tube  Desat into low 80S  4/11  Tmax 39.1 C  D/C NO  4/12  Trach aspirate culture reveals staph aureus sensitive to vanc- aztreonam vancand tobra d/c  4/13  Phenytoin D/C (Day 7)

Acute Lung Injury

 Definition
 Acute hypoxemia  Bilateral lung infiltrates on xray

Acute Lung Injury

 Nitric oxide (NO)
 Pulmonary vasodilator

Acute Lung Injury

Acute Lung Injury

 Meta-analysis revealed: Meta No affect on mortality, duration of ventilation, or ventilation days  Initial improvement in PaO2/FiO2 ratio and oxygenation  Minimal incidence of >5% methaemoglobinemia  Increased incidence of renal dysfunction
Adhikari, Neill et al. Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis. BMJ 2007 meta-

Acute Lung Injury

 Meta-analysis reveals evidence Metainadequate for regular use of NO in patients with acute lung injury or acute respiratory distress syndrome

Adhikari, Neill et al. Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis. BMJ 2007 meta-