Case 260

 We present a sixty six-year-old male for dyspnea after PTGBD (percutaneous transhepatic gall bladder drainage) for acute cholecystitis. Three months before, he got tracheotomy under artificial respiratory control for acute interstitial pneumonia. PTGBD was successful but respiratory disorder occurred two days after. Laboratory test revealed before PTGBD; white blood cells 10940/mm3, neutrophils 79%, lymphocytes 11%, monocytes 8%, CRP 17.92 mg/dL, procalcitonin 0.15mg/dL, D dimer 490 ng/mL (> 500) : two days after PTGBD, white blood cells 8310/mm3, CRP 10.41 mg/dL, KL-6 2219U/mL(< 500 U/mL). He took chest CT for further investigation (Figs 1, 2). As SpO2 lowered to 90%, he was given oxygen mask with 8L/min but hypoxia continued. Then, the rate of oxygen mask was elevated to 10L/min of the limit. SpO2 lowered 86% with FiO2 0.8. Then, tracheotomy was conducted and he was put under artificial respiratory instrument, inducing improvement, SpO2 94% with FiO2 0.5 and PEEP (positive end expiratory pressure 8mmHg).

What is the application for artificial respirator ?

A.　PF ratio more than 200 B.　PF ratio less than 100 C.　SpO2 86% FiO2 0.8 D.　SpO2 90% under 8L/min per O2 mask E.　PaO2 94% FiO2 0.4

1.　A,C,D

2.　B,C,D

3.　C,D,E

4.　All

answer

2022.3.11