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

Kinanti Narulita Dewi; Wiwi Jaya; Arie Zainul Fatoni

doi:10.15851/jap.v8n2.2072

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