2 Mucus plugs can clog the segmental airways and cause resistance to airflow. Endotracheal suctioning can be used to clear secretions but is limited to the upper, larger airways. This mucus plugging was likely as a result of aspiration of abdominal contents in setting of ileus/small bowel obstruction and altered mental status. Our patient likely had complete left lung collapse caused by mucus plugging of the lower airways. In addition, ET tube was suctioned and patient received Mucomyst via nebulization however, her oxygen saturation did not improve. Endotracheal tube was retracted from original 23 cm to 21 cm. Stat CXR obtained showed complete opacification of the left lung with leftward shift of mediastinum and volume loss suggestive of mucus plugging. Bag mask ventilation was initiated with her saturation mildly improving to the 60s. 1.5 hours later, patient decompensated with oxygen saturation in the 40s. It also showed optimal placement of ET tube, with ET tube being 4 cm above the carina. Her fraction of inspired oxygen (FiO 2) was set at 100%, tidal volume (VT) at 6 mL/kg, and positive end expiratory pressure (PEEP) at 10 cm H 2O.Ĭhest X-ray (CXR) performed after re-intubation revealed mildly worsening left lower lobe opacity. Her endotracheal (ET) tube was set at 23 cm. However, later that night, patient became increasingly tachypneic and hypoxic requiring re-intubation. She was extubated 2 days later in the early morning hours. Patient’s hospital course was complicated with worsening hypoxia and encephalopathy requiring endotracheal intubation. Surgery was consulted and initiated patient on nasogastric tube to intermittent suction. Sepsis protocol was initiated with administration of weight-based fluid boluses and empiric antibiotics. Computed tomography (CT) scan of the abdomen and pelvis revealed ileus and possible small bowel obstruction with mild opacities at bilateral lung bases. She was hypotensive on arrival with elevated lactic acid and procalcitonin. A 65-year-old woman with history of breast cancer presented with complaint of decreased food intake and general decline in health.
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