[Pickwick syndrome--problems for a surgeon and an anesthesiologist-resuscitator (clinical observation--121 days of intensive care of the patient with Pickwick syndrome)].
An analysis of a 121-day of intensive-care therapy of peritonitis and concomitant complications in a patient with Pickwick syndrome and somnolent apnea syndrome is reported. Right hemicolectomy was implemented in the patient for peritonitis, which developed on the 2nd day as a result of perforation of the blind gut at a place of tumor removed in a scheduled colonofibroscopy (CFS). The attempts of intubation of the trachea for as long as one hour failed due to the anatomic peculiarities. Tracheostomy was made. The switching-on of the patient, postoperatively, to spontaneous breathing was highly complicated because of Pickwick syndrome and the appearing dependence in the patient on the respirator. The alternating methods of respiratory support by using apparatus "Servo Ventilator 900" (Vo. Control + PEEP, SIMV, PS, regime CPAP) were a key technique of intensive care during 121 days. The postoperative cause was complicated on the 12th postoperative day by a massive gastrointestinal hemorrhage, by subsequent relaparotomy and a revision of anastomosis. The intensive-care therapy enabled, on the 80th day to transfer the patient, for 3 days, to a spontaneous independent breathing and to feed him, for 2 weeks, in the natural way. The subsequent postoperative cause was complicated by the development of massive decubituses in the lumbosacral area, and by the formation of intestinal fistula with leakages phlegmon in the anterior abdominal wall. The average cost of one day of the complex intensive-care therapy topped 5000 rubles. Because of an overweight (190 kg) the medical care rendered to the patient was complicated. The patient died on the 121 day due to intoxication, renal insufficiency and growing respiratory insufficiency. Finally, it is concluded that there is a necessity to make a motivated collective decision for carrying out any diagnostic invasive methods of examination in such category of patients; and in case of surgical interventions, the intubation of the trachea should be implemented with local spray anesthesia involving the use of fibrolaryngoscope.
Martynova
G I
GI
Altunin
A I
AI
Khandryga
B V
BV
Kurabtseva
O N
ON
Sumskiĭ
V D
VD
Popov
V A
VA
Sedov
V N
VN
Bylinskiĭ
E A
EA
Liubarskiĭ
S K
SK
Soldatov
E I
EI
D001063:Appendiceal Neoplasms / Q000150:complications / Q000601:surgery; D003422:Critical Care / Q000379:methods*; D017809:Fatal Outcome; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D006488:Hemostasis, Surgical; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D008875:Middle Aged; D010845:Obesity Hypoventilation Syndrome / Q000150:complications* / Q000628:therapy*; D010288:Parenteral Nutrition; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy