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A Man in His 60s With Renal Failure and Shock Refractory to VasopressorsRenal Failure and Shock Refractory to Vasopressors

Kerry M. Hena, MD; Lewis A. Eisen, MD, FCCP; Ariel L. Shiloh, MD
Author and Funding Information

From the Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, The Jay B. Langner Critical Care Service, Montefiore Medical Center, Bronx, NY.

CORRESPONDENCE TO: Ariel L. Shiloh, MD, Division of Critical Care Medicine, Albert Einstein College of Medicine, Critical Care Administration, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467; e-mail: arielshiloh@gmail.com


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(6):e171-e174. doi:10.1378/chest.15-0160
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Extract

A 64-year-old man with coronary artery disease, chronic systolic heart failure, and bioprosthetic mitral valve replacement presented to the ED with diffuse body pain and weakness. Initial workup revealed acute renal failure and hypotension. The patient received 2 L of normal saline but remained hypotensive, and a left internal jugular central venous catheter was placed by the ED team. A critical care medicine consult was called for further assistance with renal failure, severe acidemia, and shock state.

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Figures

Tables

Video 1

Left pleural effusion.

Video 2

Demonstration of the catheter within the pleural space.

Video 3

Bubble study confirming the catheter within the pleural space.

Video 4

Demonstration of the extravascular placement of the catheter within the soft tissue.

Video 5

Discussion video.

Running Time: 3:14

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