Correct!
1. Infection
A number of years ago the group in Seattle pointed out that late in ARDS the major cause of mortality was infection, often from a lung source (5). After about 2 weeks, she developed fevers and leukocytosis. Bronchoscopy revealed E. coli. Despite appropriate antibiotics she continued with worsening leukocytosis and fevers. A CT scan was performed revealing bilateral loculated pleural effusion (Figure 2) and she had minimal drainage from her chest tubes.
Figure 2. CT chest 2 for evaluation of fevers and leukocytosis two weeks after motor vehicle collision
Tissue plasminogen activator (TPA) was administered through the left chest tube drain into the area thought to be empyema without improvement in leukocytosis or fevers. A pigtailed catheter was inserted into the small right pleural effusion with instillation of TPA. Also a pericardial window and drainage of a pericardial effusion was performed. All cultures of fluid were negative. With drainage of the right loculated effusion and the pericardial effusion her leukocytosis and fevers improved.
The pericardial effusion was thought to be secondary to inflammatory etiology due to open cardiac massage during Advanced Trauma Life Support in the initial cardiac arrest during presentation.
At this time she has had a tracheostomy and continues to receive mechanical ventilation in the ICU. However, it is anticipated that she will survive her ordeal, hopefully with little residual functional deficiency.
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