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Can J Anesth/J Can Anesth (2011) 58:396400
DOI 10.1007/s12630-011-9459-9
CASE REPORTS/CASE SERIES
Dynamic hyperination and cardiac arrest during one-lung ventilation: a case report
Hyperination dynamique et arrt cardiaque pendant la ventilation slective: une prsentation de cas
Katherine Marseu, MD Peter Slinger, MD
Marc de Perrot, MD Karen McRae, MD
Martin Ma, MD
Received: 25 October 2010 / Accepted: 6 January 2011 / Published online: 22 January 2011 Canadian Anesthesiologists Society 2011
AbstractPurpose Dynamic hyperination describes the phenomenon of progressive gas trapping that occurs in patients with severe airow obstruction. It is associated with signicant hemodynamic instability and may precipitate cardiac arrest. This report describes a case of hemodynamic collapse secondary to dynamic hyperination in a patient during one-lung ventilation.
Clinical features A 50-yr-old male with a pneumothorax secondary to a ruptured bulla was transferred to the operating room for a left bullectomy. Approximately 30 minutes after initiation of one-lung ventilation in the right lateral decubitus position, sudden ST segment elevation and hypotension occurred, which was refractory to large doses of vasopressor. This culminated in a pulseless electrical activity arrest. The patient was immediately placed supine, disconnected from the ventilator circuit, and resuscitated with chest compressions, uids, and epinephrine. Auscultation of the right chest revealed no air entry, and needle decompression followed by chest tube insertion in the right chest did not demonstrate any evidence of a pneumothorax. Approximately three to ve minutes after the onset of the arrest, the patients hemodynamics
stabilized and there was no evidence of ST elevation. The etiology of the arrest was likely due to dynamic hyperination.
Conclusion This report highlights the importance of having a high index of suspicion for dynamic hyperination and the key to its treatment: disconnection from the ventilator circuit and cessation of mechanical ventilation to allow the lungs to return to functional residual capacity.
RsumObjectif Le terme dhyperination dynamique fait rfrence au phnomne de pigeage des gaz qui survient chez les patients souffrant dobstruction grave des voies ariennes. Cet vnement est associ une importante instabilit hmodynamique et peut mener un arrt cardiaque. Ce rapport dcrit un cas de collapsus hmodynamique secondaire une hyperination dynamique chez un patient durant une ventilation slective. lments cliniques Un homme de 50 ans prsentant un pneumothorax la suite dune rupture...