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DIALYSIS INDUCED HYPOXEMIA (TRUE ONGOING CASE TELL ME WHAT YOU THINK)

I have a patient who is his mid 40's in my CCU on a ventilator for respiratory failure 2ndary to alcohol induced pancreatitis, ARDS, acute renal failure, alcohol withdrawal. CXR shows bilateral infiltrates and pleural effusions. He was fluid resuscitated, intubated and emergency dialysis was started due to his potassium of 7 and low urine output. A-line and central line are in place with normal readings. The patient is currently on Bi-Level with the 840 with an fio2 of 100%. Fio2 weaning protocol is in place which gives us the authority to wean down the fI02. The past three nights I have weaned down the Fio2 to about 60%. At least one time per shift the Fio2 has to be increased back to 100% and we are unable to wean the patients fIO2. I would then again on nights to wean down the oxygen to around 60%. I reviewed the patients chart and noticed a similarity that everytime the patient is on dialysis his saturation drops into the mid 80's and we have to increase the patients Fio2. The patients vascath is located in the left femoral area not other shunts are noted. Pulse oximeter is located on the patients left ear. No embolisms have been noted in physical examination of the lower extremities or confirmed with spiral CT. Equipment involved are the 840 ventilator and a new dialysis machine I dont know the make or model.. Neuro he is intact and follows commands when he recieves a sedation vacation. Now lets discuss what could be going on. Also, blood pressure remains stable during dialysis

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Permalink Reply by matthew lipsey on April 25, 2009 at 11:44pm
On the first shot and a piece of the picture is revealed. You are on the right path and that was one of the first items addressed now more information. lipase over 1200. Now has been having a temperature over 102. Last night I weaned Fio2 down to 40% without a problem. Before I left his temperature spiked over 102 which means the o2 dissosciation curve went to the left I had to increase his Fio2 to 80%. This time the hypoxemia wasnt dialysis related he now has a temp. But still dont exclude the membrane of the dialysis machine it does have a place in this case study.
Permalink Reply by Jeff Whitnack on November 5, 2009 at 8:58am
I saw a study whereby during dialysis the lower PaCO2 means the patient spontaneously breathes less, so hypoxemia sets in.

But your patient is intubated. On BiLevel how much spontaneous breathing is he doing? And by spontaneous I mean either done is modes designated such (PS, APRV or BiLevel, Spont) or spontaneously breathing via assisting over set backup rate in A/C or SIMV).

The other possibility is that the systemic BP drops and a PFO opens...but you said his BP is stable. ??
Permalink Reply by Mike Sheehan on January 18, 2012 at 6:14am

Man this is such an old post, what ever happened to this patient?

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