Pulmonary arteriovenous fistula: mechanical ventilation and hypoxemia.
Pulmonary arteriovenous malformation (PAVM) is an uncommon congenital anomaly. As PAVM is a direct communication between branches of the pulmonary artery and vein, major disturbances in gas exchange can result. We present a patient with an unsuspected PAVM who came to our institution for drainage of a brain abscess. Arterial blood gas analysis during and after surgery demonstrated a large alveolar-arterial gradient for oxygen in the absence of any obvious pulmonary pathology while the patient was receiving positive pressure ventilation (PPV). Oxygenation improved considerably upon resumption of spontaneous ventilation. A diagnosis of PAVM was made subsequently. We conclude that positive pressure ventilation can worsen right to left shunting in patients with PAVM.
Friedman
B C
BC
Department of Anesthesia and Critical Care, George Washington University Medical Center.
McGrath
B J
BJ
Williams
J F
JF
D000328:Adult; D001165:Arteriovenous Malformations / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D008168:Lung / Q000098:blood supply*; D008297:Male; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration / Q000009:adverse effects*; D011659:Pulmonary Gas Exchange / Q000502:physiology
D010100:Oxygen