A Unique Cause for Ventilator Alarm

Editorial

Austin Crit Care Case Rep. 2019; 3(1): 1011.

A Unique Cause for Ventilator Alarm

Jennifer R. Ely, DO*

Department of Pulmonary Medicine, Sparrow Hospital, Michigan, USA

*Corresponding author: Jennifer R. Ely, DO, Department of Pulmonary Medicine, Sparrow Hospital, Michigan, USA

Received: December 10, 2018; Accepted: February 06, 2019; Published: February 13, 2019

Editorial

RM is a 26-year-old male patient with a known history of seizure disorder and substance abuse who presented to the local emergency room via EMS after being found with a decreased level of consciousness. He was noted to have two Fentanyl patches on his body and Narcan was given by EMS prior to arrival to the emergency room.

In the ER the patient had a seizure and an episode of emesis. The decision was made to intubate the patient. Two additional Fentanyl patches were noted in the oropharynx and were removed. During intubation there was no noted obstruction of the vocal cords or evidence of aspiration. He was then admitted to the intensive care unit.

During his time in the ICU he was noted to have intermittent episodes of high peak pressure. Ventilator setting changes were made which only partially helped. Respiratory therapy also noted difficulty passing the suction catheter, but this too was intermittent and seemed to coincide with the peak airway issues. His initial CXR Figure 1 showed some pulmonary edema and a right basilar infiltrate. This right basilar infiltrate did worsen some in the ICU. The findings on his CXR did not account for his ventilator issues. Decision was made to do a fiberoptic bronchoscopy. This revealed a Fentanyl patch at the distal end of the endotracheal tube just above the level of the carina (Figure 2,3). The patch was removed by holding onto the patch with biopsy forceps while extubating the patient. The patient was immediately reintubated. Bronchoscopy after patch removal did not demonstrate any evidence of additional foreign bodies. The airway exam demonstrates diffuse airway edema. After bronchoscopy was completed it was also noted that a piece of a patch was pulled out by NGT. This prompted an EGD. This demonstrated esophagitis thought to be secondary to the Fentanyl patches, but no actual patches were found. A duodenal ulcer was also noted. The patient was successfully extubated after being treated for overdose and aspiration pneumonia. He was discharged from the ICU and hospital.