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Acute Hypoxemic Respiratory Failure: Ultrasound to the Rescue

Author
Ziyad Al-Shathri
Pulmonary and Critical Care Fellow
George Washington University, Washington DC


Case

A 62-year-old male was admitted with sepsis from a foot ulcer. His vitals were as follows: BP 110/60 mmHg, RR 25/min. Pulse 110/min and Temperature of 101F. He was started on antibiotics and given two liters isotonic saline bolus. His admission chest radiograph showed no infiltrates. On the next day the ulcer was debrided in the operating room and he received 5 liters of saline during the procedure. Immediately after the debridement he went into respiratory distress and was intubated for hypoxemic respiratory failure. On examination he had bilateral crackles on auscultation and his chest radiograph showed bilateral alveolar infiltrates. Bedside echocardiography showed normal left ventricular function with an estimated ejection fraction of 55%, normal diastolic filling pressures (E/e’ of 4) and an inferior vena cava diameter of 1.5 cm.

Lung sonography was performed. There was no pleural effusion on either side.

Lung Sonography
Lung Sonography
Lung Sonography

Question

The likely cause of acute hypoxemic respiratory failure in this case is:

A. Cardiogenic pulmonary edema
B. Acute Respiratory Distress Syndrome (ARDS)
C. COPD exacerbation
D. Pulmonary embolism

Answer