Hidrotoraks Masif Dekstra dengan Penyulit ARDS Akibat Komplikasi Pemasangan Kateter Vena Sentral Jugular Interna

Kinanti Narulita Dewi, Wiwi Jaya, Arie Zainul Fatoni

Abstract


Hidrotoraks merupakan komplikasi yang jarang terjadi akibat pemasangan kateter vena sentral dengan angka insidensi 0,4–1,0%. Insidensi komplikasi mekanik lebih rendah pada insersi vena jugularis dibanding dengan vena subklavia. Pada kasus ini, kami melaporkan pasien laki-laki berusia 63 tahun dengan berat badan 70 kg. Pasien dengan ASA 4E sepsis dan curiga keganasan. Pasien ini didiagnosis akut abdomen karena  total bowel obstruction dan rencana dilakukan tindakan laparotomi dengan anestesi umum. Pasien ini telah dipasang kateter vena sentral saat di IGD. Pasien dilakukan tindakan anestesi umum selama 3 jam dan mendapatkan cairan intraoperatif 1.500 cc melalui kateter vena sentral. Pascaoperasi, pasien tidak dapat dilakukan ekstubasi karena napas tidak adekuat dan hemodinamik tidak stabil sehingga pasien dirawat di ruang ICU. Saat pasien tiba di ruang ICU, pada pemeriksaan fisis ditemukan suara napas paru kanan menurun dan perkusi redup pada paru kanan. Hasil analisis gas darah menunjukkan hipoksemia berat dan asidosis. Pemeriksaan foto rontgen dada ditemukan gambaran efusi pleura masif. Kami melakukan evakuasi kurang lebih 2,2 liter cairan berwarna kemerahan dari kavum pleura dan memasang selang chest tube pada paru kanan. Pasien mengalami acute respiratory distress syndrome (ARDS). Tata laksana pasien dengan sepsis dan ARDS berfokus pada prinsip lung protective strategy dan sepsis bundle sesuai dengan surviving sepsis campaign (SSC) 2018.


Right Massive Hydrothorax with ARDS due to Complication of Internal Jugular Central Venous Catheter Insertion

Hydrothorax is a rare complication seen in approximately 0.4–1.0 % of all catheter placements. The major mechanical complication incidence of internal jugular vein insertion is lower than the one in the subclavia vein. This study presented a case of a 63-year-old, 70 kg man with ASA 4E sepsis and suspected malignancy. Patient was diagnosed with acute abdomen pain due to total bowel obstruction and underwent exploratory laparotomy with general anesthesia. A right jugular central venous catheter (CVC) was inserted in the ER. Patient was under general anesthesia for 3 hours and 1,500 cc intra operative fluid was administered through the CVC. After surgery, the patient experienced extubation failure and was admitted to ICU because of inadequate spontaneous breathing and hemodynamic instability. Patient experienced reduced breath sound and the resonance to percussion was dull in the right hemithorax. The BGA presented severe hypoxemia and acidosis while the chest x-ray showed right sided massive pleural effusion. Almost 2.2 liter of clear reddish fluid was drained from pleural cavity and a chest tube was inserted. Patient was then diagnosed as having acute respiratory distress syndrome (ARDS). Treatment for sepsis and ARDS was then given by focusing on the principle of lung protective strategy and sepsis bundle according to surviving sepsis campaign (SSC) 2018.


Keywords


ARDS, hidrotoraks, kateter vena sentral, komplikasi, sepsis

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References


Jha M, Kumar S, Bokil S, Galante D. Complications of central venous catheter cannulation in tertiary care hospital ICU, a 2 years retrospective, observational study. Pediat Anesth Crit Care J. 2013;1(2):87–92.

Adipurna RP, Fatoni AZ. Catheter related bloodstream infection (CRBI) management in the Intensive Care Unit (ICU). J Anaesth Pain. 2020;1(2):11–8.

Wong AVK, Arora N, Olusanya O, Sharif B, Lundin RM, Dhadda A, dkk. Insertion rates and complications of central lines in the UK population: a pilot study. J Intens Care Soc. 2018;19(1):19–25.

Omar HR, Fathy A, Elghonemy M, Rashad R, Helal E, Mangar D, dkk. Massive hydrothorax following subclavian vein catheterization. Intern Archiv Med. 2010;3(32):1–3.

Bohendam AR, Simcock L. Central venous catheters: complications of central venous access. Dalam: Hamilton H, Bodenham AR, penyunting. Edisi ke-1. United Kingdom: Wiley-Blackwell; 2009. hlm. 175–9.

Kim SH, Her C. Central venous catheter-related hydrothorax. Korean J Crit Care Med. 2015;30(4):343–8.

Ki S, Kim M, Lee W, Cho H. Tension hydrothorax induced by malposition of central venous catheter. Anesth Pain Med. 2017;12:151–4.

Khemakhem R, Riazulhaq M, Sadok RM, Ghamdi HA. Bilateral hydrothorax after left internal jugular venous catheterization in infant. Clin Surg. 2017;(2):1–3.

Marino PL, Galvagno SM. Marino’s The Little ICU Book. Edisi ke-2. New York: Wolters Kluwer; 2017.

Kreit JW. Acute respiratory distress syndrome (ARDS). Mechanical ventilation physiology and practice. Edisi ke-2. England: Oxford University Press; 2018;183–206.

Karnik PP, Shah HB, Dave NM, Garasia M. Massive pleural effusion following central venous catheter migration: tips to remember. Pediat Anesth Crit Care J. 2016;4(2):83–5.

Keyvan R, Thille AW, Carteaux G, Beji O, Christian Brun-Buisson C, Brochard L, dkk. Effects of pleural effusion drainage on oxygenation, respiratory mechanics, and hemodynamics in mechanically ventilated patients. Am Thorac Soc J. 2014;11(7):1018–24.

Kim WY, Hong SB. Sepsis and acute respiratory distress syndrome: recent update. Tubercul Respirat Dis J. 2016;79(2):53–7.

McCormack V, Tolhurst-Cleaver S. Acute respiratory distress syndrome. BJA Educat. 2017;17(5):161–5.

Hess DR, Kacmarek RM. Acute respiratory distress syndrome. Essential of mechanical ventilation. Edisi ke-3. England: Oxford University Press; 2019;181–94.

Dugar S, Choudhary C, Duggal A. Sepsis and septic shock: guideline-based management. Clevel Clin J Med. 2020;87 (1):64.

Englert JA, Bobba C, Baron R.M. Integrating molecular pathogenesis and clinical translation in sepsis-induced acute respiratory distress syndrome. JCI Insight. 2019;4(2):1–13.

Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Crit Care Med J. 2018;46(6):997–1.000.

Kreit JW. Discontinuing mechanical ventilation. Mechanical ventilation physiology and practice. Edisi ke-2. England: Oxford University Press; 2018;220–33.

Kwon H-J, Jeong Y-I, Jun I-G, Moon Y-J, Lee Y-M. Evaluation of a central venous catheter tip placement for superior vena cava–subclavian central venous catheterization using a premeasured length: a retrospective study. Medicine. 2018;97(2):1–4.

Lee JB, Lee YM. Pre-measured length using landmarks on posteroanterior chest radiographs for placement of the tip of a central venous catheter in the superior vena cava. J Int Med Res. 2010;38:134–41.

Saugel B, Scheeren TWL, Teboul J-L. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 2017;21(1):225

Shin H-J, Na H-S, Koh W-U, Ro Y-J, Lee J-M, Choi Y-J, Park S. Complications in internal jugular vs subclavian ultrasound-guided central venous catheterization: a comparative randomized trial. Intensi Care Med. 2019;45:968–76.

Midha D, Chawla V, Kumar A, Mandal AK. Ultrasound guidance for central venous catheterization: a step further to prevent malposition of central venous catheter before radiographic confirmation. In J Crit Care Med. 2017;21(7):463–5.

Franco-Sadud R, Schnobrich D, Mathews BK, Candotti C, Abdel-Ghani S, Perez MG, dkk. Recommendations on the use of ultrasound guidance for central and peripheral vascular access in adults: a position statement of the society of hospital medicine.J Hosp Med. 2019;14(1):E1–22.

Hamilton H, Bodenham A. Central venous catheters. New Jersey: Wiley-Blackwell; 2009.




DOI: https://doi.org/10.15851/jap.v8n2.2072



 

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