Indian Journal of Respiratory Care

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VOLUME 12 , ISSUE 4 ( October-December, 2023 ) > List of Articles

CASE REPORT

A Case Report on Use of Anesthetic Conserving Device in a Patient with Bullous Cystic Lung Disease

Kankana D Samanta, Arindam Kar

Keywords : Anesthetic conserving device, Case report, Chronic obstructive pulmonary disease, Hypercarbia, Mechanical ventilator, Weaning

Citation Information : Samanta KD, Kar A. A Case Report on Use of Anesthetic Conserving Device in a Patient with Bullous Cystic Lung Disease. Indian J Respir Care 2023; 12 (4):355-357.

DOI: 10.5005/jp-journals-11010-1073

License: CC BY-NC-SA 4.0

Published Online: 18-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aim and background: Mechanical ventilation is a lifesaving intervention used in critically ill patients with respiratory failure. However, it is not without risks, as it can cause harm to the lungs, increase the need for sedatives and analgesics, and prolong the time patients spend on mechanical ventilation. One way to mitigate these risks is by using an anesthetic conserving device (ACD). With the use of ACD, the use of volatile anesthetics like sevoflurane has been available for intensive care unit (ICU) critically ill patients having chronic pulmonary diseases for faster awakening, preventing critical myopathy and quicker weaning from the ventilator. Case description: In this case study, a 42-year-old female patient presented to the emergency room (ER) with a complaint of breathlessness persisting for 2 days. The patient had a medical history of left recurrent pneumothorax and bullous cystic lung disease. Upon admission to the ER, the patient exhibited drowsiness and hypotension, and arterial blood gas (ABG) analysis revealed severe respiratory acidosis. Consequently, the medical team decided to intubate the patient using pressure-regulated volume control (PRVC) ventilation while administering sedation and paralysis with atracurium, fentanyl, and a ketamine infusion. The use of ketamine infusion was initiated due to the acute exacerbation of chronic obstructive pulmonary disease (COPD), specifically type II respiratory failure. Employing an ACD proved to be highly beneficial in enhancing gas exchange and achieving more effective sedation. This approach facilitated quicker awakening and smoother weaning trials, a significant advantage when dealing with chronic pulmonary patients on mechanical ventilation. Remarkably, the patient was successfully transitioned to pressure support ventilation mode within just 4 days of implementing the ACD. Subsequently, the patient was extubated and placed on noninvasive ventilation, marking a successful outcome. Conclusion: This is a case study on the use of an ACD that facilitated quicker awakening and improved gas exchange, thereby reducing hypercarbia and peak airway pressures. Ultimately, this led to quicker weaning from the ventilator. Clinical significance: By utilizing an ACD, it has become possible to administer volatile anesthetics such as sevoflurane to critically ill patients in the ICU who suffer from chronic pulmonary diseases. This approach facilitates quicker awakening, helps prevent critical myopathy, and expedites the process of weaning patients from ventilatory support.


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