Intubation & Ventilation Scenario 7

A 59 year old woman is admitted for investigation of possible ovarian carcinoma, she has been complaining of shortness of breath for the past three weeks. You are called because she is now severely dyspneic – PCO2 60mmHg PO2 50mmHg.

Failure to ventilate, associated failure to oxygenate
Loss of chest wall compliance.

Solution

There are a variety of reasons why this patient could become short of breath. When you go to examine her, her abdomen is globular and tense (ascites) and her lung bases are stony dull to percussion with absent breath sounds (pleural effusion). The combination of the two leads to a huge reduction is the expandability of the lungs (compliance). The diaphragm cannot move effectively down into the abdomen (reduced minute ventilation), and lung tissue is squashed by the effusions (reduced functional residual capacity).