Correct!
3. Antibiotics
5. Diuresis
Broad spectrum antibiotics for possible hospital acquired pneumonia would seem appropriate as would diuresis for possible cardiogenic pulmonary edema. Neither right heart catherization nor bronchoscopy are wrong but seem overly aggressive at this time. Steroids would not seem appropriate in the absence of a diagnosis and open lung biopsy seems overly aggressive at this stage.
The patient received piperacillin/tazobactam, levofloxacin and vancomycin were started. His WBC decreased to 10X103 cells/mm3 and his fever resolved. He received diuresis with furosemide and his weight decreased by 2 kg. However, he failed to clinically improve.
Because of his failure to improve right heart catherization was performed with the major results below:
Pulmonary artery pressure: 36/16 (24 mean) cm H2O
Wedge: 16 cm H2O
Cardiac output: 5.8 L/min
His CT scan was repeated (Figure 3).
Figure 3. Representative images from the repeat CT scan. (click here for a movie of the CT scan)
What should be done next?
