INTRA-ABDOMINAL PERFORATION DUE TO CARDIOPULMONARY RESUSCITATION FOLLOWING NON-INVASIVE MECHANICAL VENTILATION IN AN ELDERLY PATIENT
Gülşah KARAÖREN, Şenay Göksu TOMRUK, Hacer Burcu ÇİFT, Kerem TOLAN, Yusuf DEMİR, Nurten BAKAN
Ãœmraniye Training and Research Hospital, Department of Anesthesiology and Reanimation, Ä°STANBUL
Medical treatment with non-invasive mechanical ventilation is the gold standard for elderly patients with acute exacerbation of chronic obstructive pulmonary disease who may develop respiratory failure. However, for geriatric patients needing high-pressure support, non-invasive mechanical ventilation may lead to gastric distension associated with the passage of air into the esophagus and stomach. There are very few cases in literature of gastric perforation developing secondary to gastric distension. In these patients, cardiopulmonary resuscitation increases potential risks by engendering an increase in intra-thoracic and intra-abdominal pressure. After intubation, gastric air decompression with a nasogastric catheter will protect patients from omplications such as gastric distension, aspiration and gastric perforation.
In this case report, we present an 84-year-old patient with severe exacerbation of chronic obstructive pulmonary disease, who was treated with non-invasive mechanical ventilation at intermittent high pressures for 6 hours in the emergency department but suffered a cardiac arrest because of respiratory failure. Cardiopulmonary resuscitation was then applied, resulting in the development of pneumomediastinum, pneumoperitoneum and bilateral rectus abdominis rupture associated with gastric perforation.
Due to increased tissue fragility in this age group, complications which may develop from non-invasive mechanical ventilation, which has been applied to avoid the undesired effects of intubation in elderly patients, are of greater importance and should not be ignored.
Keywords :
Noninvasive Ventilation; Cardiopulmonary Resuscitation; Perforation; Pulmonary Disease, Chronic Obstructive; Mediastinal Emphysema; Pneumoperitoneum
