A Novel Ventilatory Technique in Refractory Hypoxemic Respiratory Failure Secondary to Therapeutic Thoracentesis and Paracentesis

Patient: Male, 61-year-old Final Diagnosis: Hypoxemic respiratory failure • reperfusion pulmonary edema Symptoms: Respiratory deterioration Medication: — Clinical Procedure: — Specialty: Critical Care Medicine OBJECTIVE: Unusual or unexpected effect of treatment BACKGROUND: MetaNeb(®) is a respiratory therapy modality that aims to effect clearance of airway secretions through chest physiotherapy. It typically is used in critically ill patients with bronchiectasis or copious secretions. However, it also expands lungs through a continuous positive expiratory pressure and continuous high-frequency oscillation, which has the benefit of increasing lung recruitment and improving oxygenation. CASE REPORT: A 61-year-old male who had re-expansion pulmonary edema following a paracentesis and thoracentesis for cirrhosis, which caused a large unilateral pleural effusion. He required intubation and his hypoxemia was refractory to standard maximum ventilatory measures. A trial of continuous MetaNeb(®) acted as a noninvasive extracorporeal membrane oxygenation method, dramatically improving oxygenation and hypoxemia, normalizing the patient’s blood gas, and thus stabilizing him. CONCLUSIONS: MetaNeb(®) could potentially be used in other community hospitals that lack the capability for advanced ventilatory modes or in patients who are too unstable for transfer.