[Noncardiogenic pulmonary edema and acute kidney failure after withdrawal of a central venous catheter].
A 17-year-old male suffered severe noncardiogenic pulmonary edema with arterial hypotension and acute renal insufficiency after withdrawal of a central venous catheter from the subclavian vein. The patient was in semirecumbent supine position with the head of the bed at a 40 degree angle. Resuscitation maneuvers, orotracheal intubation, and hemodynamic support were required. After 4 days in intensive care the patient had fully recovered. Fibrin tracts form around catheters and can create a way for air to enter a vein after catheter removal. The causes of pulmonary edema secondary to venous air embolism have been well studied: it seems that edema develops as a consequence of the sudden appearance of small air bubbles in pulmonary circulation, leading to an acute inflammatory response in pulmonary microvasculature. Experimental studies have shown that edema is associated with increased pulmonary vascular resistance that leads to pulmonary hypertension. Venous air embolism as a complication of central venous catheterization is too seldom detected and little stress is placed on this possibility in the care and removal of catheters.
Serrano Casabón
S
S
Servicio de Anestesiología y Reanimación, Hospital Clínic i Provincial, Universidad de Barcelona. 34114ssc@comb.es
Fàbregas Julià
N
N
Fernánndez Candil
J
J
Adalia Bartolomé
R
R
Agustí Lasús
M
M
Zavala Zegarra
E
E
D058186:Acute Kidney Injury / Q000209:etiology*; D000293:Adolescent; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011654:Pulmonary Edema / Q000209:etiology*