Mohamed Abbasy
Hamad Medical Corporation, Qatar
Title: Trendelenburg position associated with a serious complication, a clinical warning
Biography
Biography: Mohamed Abbasy
Abstract
Internal jugular central venous catheterization (IJCV) is an everyday practice in the Emergency Department and Trendelenburg position is widely recommended to facilitate such a procedure. Reported complications range from 5% to 20% and include pneumothorax, hydrothorax and injuries to major structures. Here we report a 47 year old male patient, known to have chronic bronchitis and alcoholic liver disease, he presented to the emergency department with a circulatory collapse due to an acute pancreatitis. In trendelenberg position, right IJ CVC was inserted under ultrasound guidance. Post procedure chest X-ray showed right upper lobe lung collapse which progressed after 2 hours into a total lung collapse and hypoxia. Endotracheal intubation with mechanical ventilation was required and subsequent computed tomographic Angiography confirmed in place catheter with no extravasation but a large volume pleural effusion associated with complete lung collapse on the right side. Urgent bedside Bronchoscopy, revealed a large mucous plug occluding the right main bronchus with a smaller one at the right upper branching bronchus both were removed immediately. Repeated chest X-ray after 6 hours showed lung expansion with a dramatic decrease of the volume of pleural effusion. Patient was extubated on day three of admission and left the hospital with a full neurological and respiratory recovery on the seventh day. Such a complication was never reported before. We suggest that prolonged trendelenburge positioning in susceptible patients can be associated with significant morbidities including mucus plug and total lung collapse and maybe it is safer to be avoided in patients with reactive airway disease.
