CASE
A 60-year-old male presented to the emergency department at midnight through referral by another hospital, where he underwent transcatheter arterial embolization (TAE) for pelvic bleeding that developed after falling from a height of 9 m. The patient’s vital signs were as follows: systolic blood pressure, 70 mm Hg; pulse rate, 128 beats/min; respiration rate, 40 breaths/min; body temperature, 36.3°C; and oxygen saturation, 89%. Accordingly, immediate intubation and mechanical ventilation were performed. His initial arterial blood gas analysis (ABGA) revealed a pH of 6.99, HCO3− of 10.8, lactic acid profile of 13.5 mmol/L, and a base excess of −19.6. Abdominal CT after fluid resuscitation demonstrated an unstable pelvic ring fracture (Fig. 1.). The patient was therefore suspected of hemorrhagic shock caused by persistent bleeding from the blood vessels in the pelvis. Therefore, we decided to perform TAE for hemorrhage control. Priming of the continuous renal replacement therapy (CRRT) was conducted during the interventional radiologist’s visit to the hospital. A catheter was inserted via the left femoral vein in the intervention room immediately before angiography, and CRRT was performed during TAE (Fig. 2.). In the subsequent angiography, bleeding was observed in the right iliolumbar and both the internal pudendal arteries, and embolization was performed (Fig. 3.). Treatment, including CRRT, was performed in the trauma intensive care unit after TAE.
Vital signs observed immediately after the TAE were as follows: blood pressure, 135/79 mm Hg; pulse rate, 135 beats/min; and body temperature, 36.5°C. In addition, ABGA revealed a pH of 7.18, HCO3− of 10.8, lactic acid profile of 7.2 mmol/L, and a base excess of −11.3. Moreover, his vital signs at 6 h after the TAE were more stable, as follows: blood pressure, 124/57 mm Hg; pulse rate, 77 beats/min; and body temperature, 37.0°C. Furthermore, his ABGA revealed a pH of 7.38, HCO3− of 22.5, lactic acid profile of 7.2 mmol/L, and a base excess of −1.0. (Table 1.). CRRT was applied only on day 1. On the same day, an iliosacral screw was fixed. After 4 weeks of admission, the patient was transferred to a rehabilitation hospital without any specific complications.
DISCUSSION
Lactic acidosis is associated with high morbidity and mortality. Its treatment involves correction of the underlying causes of the disease and optimizing adequate oxygen delivery to the affected tissues [1]. CRRT is a renal replacement therapy intended to be continuously applied for 24 h in an ICU set-up [2].
If TAE is required to stop bleeding in a patient with severe lactic acidosis, CRRT operation during TAE is one of the factors that can improve acidosis. However, it is also important to not waste considerable time in operating CRRT in an intervention room. Therefore, we suggest priming the CRRT before the interventional radiologist’s visit to the hospital.
PDF Links
PubReader
ePub Link
XML Download
Full text via DOI
Download Citation
Print
