Indian Journal of Critical Care Case Report

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VOLUME 1 , ISSUE 2 ( September-October, 2022 ) > List of Articles

CASE REPORT

Refractory Hypoxemia with Hepatopulmonary Syndrome following Liver Transplant: Is there a Role of Trendelenburg Position? A Case Report

Kinjal K Purohit, Harda H Shah, Harsh J Panchal, Pranjal Modi, Bharat Tiwari

Keywords : Hepatopulmonary syndrome, Hypoxemia, Liver transplantation, Mechanical ventilation, Trendelenburg positioning, Ventilation perfusion mismatch

Citation Information : Purohit KK, Shah HH, Panchal HJ, Modi P, Tiwari B. Refractory Hypoxemia with Hepatopulmonary Syndrome following Liver Transplant: Is there a Role of Trendelenburg Position? A Case Report. 2022; 1 (2):42-45.

DOI: 10.5005/jp-journals-11006-0016

License: CC BY-NC 4.0

Published Online: 04-11-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

We report a case of a 50-year-old man who underwent liver transplantation for severe hepatopulmonary syndrome. Preoperatively, patient had orthodeoxia and platypnea leading to severe hypoxemia, requiring home oxygen therapy. Postoperatively, Trendelenburg position was given for the management of refractory hypoxemia. The outcome was measured by oxygen saturation using pulse oximetry and partial pressure of oxygen in ABGA. Post-transplant hypoxia for HPS can be managed in multiple ways but out of all of them, positioning is a simple maneuver without any severe complications that may correct the pathophysiologic abnormalities seen in HPS by gravitationally shifting blood away from the lung bases to improve oxygenation.


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  1. Arguedas MR, Singh H, Faulk DK, et al. Utility of pulse oximetry screening for hepatopulmonary syndrome. Clin Gastroenterol Hepatol 2007;5(6):749–754. DOI: 10.1016/j.cgh.2006.12.003
  2. Lima BLG, França AVC, Pazin-Filho A, et al. Frequency, clinical characteristics, and respiratory parameters of hepatopulmonary syndrome. Mayo Clin Proc 2004;79(1):42–48. DOI: 10.4065/79.1.42
  3. Raevens S, Geerts A, Van Steenkiste C, et al. Hepatopulmonary syndrome and portopulmonary hypertension: recent knowledge in pathogenesis and overview of clinical assessment. Liver Int 2015;35(6):1646–1660. DOI: 10.1111/liv.12791
  4. Benz F, Mohr R, Tacke F, et al. Pulmonary complications in patients with liver cirrhosis. J Transl Int Med 2020;8(3):150–158. DOI: 10.2478/jtim-2020-0024
  5. Schiffer E, Majno P, Mentha G, et al. Hepatopulmonary syndrome increases the postoperative mortality rate following liver transplantation: a prospective study in 90 patients. Am J Transplant 2006;6(6):1430–1437. DOI: 10.1111/j.1600-6143.2006.01334.x
  6. Guérin C, Albert RK, Beitler J, et al. Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med 2020;46(12):2385–2396. DOI: 10.1007/s00134-020-06306-w
  7. Wu D, Wu C, Zhang S, et al. Risk factors of ventilator-associated pneumonia in critically III patients. Front Pharmacol 2019;10:482. DOI: 10.3389/fphar.2019.00482
  8. Castro M, Krowka MJ. Hepatopulmonary syndrome. A pulmonary vascular complication of liver disease. Clin Chest Med 1996;17(1):35–48. DOI: 10.1016/s0272-5231(05)70297-5
  9. Gupta S, Castel H, Rao RV, et al. Improved survival after liver transplantation in patients with hepatopulmonary syndrome. Am J Transplant 2010;10(2):354–363. DOI: 10.1111/j.1600-6143.2009.02822.x
  10. Nayyar D, Man HSJ, Granton J, et al. Proposed management algorithm for severe hypoxemia after liver transplantation in the hepatopulmonary syndrome: posttransplant hypoxemia management in HPS. Am J Transplant 2015;15(4):903–913. DOI: 10.1111/ajt.13177
  11. Gallerini S, Calchetti B, Cianchi C, et al. Can patent foramen ovale affect rehabilitation? The uncommon association of platypnea-orthodeoxia syndrome and stroke. Neurol Sci 2011;32(3):513–514. DOI: 10.1007/s10072-011-0572-x
  12. Meyers C, Low L, Kaufman L, et al. Trendelenburg positioning and continuous lateral rotation improve oxygenation in hepatopulmonary syndrome after liver transplantation. Liver Transpl Surg 1998;4(6):510–512. DOI: 10.1002/lt.500040608
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