Milzruptur als Komplikation bei Beatmung in Bauchlage und Pneumokokkensepsis als Spätkomplikation

Abstract

We are reporting the case of a female patient who had to undergo splenectomy after she suffered splenic rupture as a result from "kinetic therapy" during the treatment for pulmonary failure secondary to sepsis. Four years later the patient was again admitted with a clinical picture consistent with sepsis. Two blood cultures were positive for pneumococci confirming the diagnosis of pneumococcal sepsis. This paper discusses the potential risks of kinetic therapy in patients with ARDS. After splenectomy there is increased risk of infection with certain bacteria, funghi, viruses and protozoa. The most common bacterial pathogen is pneumococcus. A polyvalent vaccine is available for prophylaxis. Although penicillin G is still commonly used as an antibiotic therapy for pneumococcal infection, increased resistance of pathogens to penicillin must be anticipated. Alternative antibiotic regimens are demonstrated.

S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders

“…The following complications were described while in the prone positions [ 28 , 30 , 42 , 43 , 65 , 105 , 124 , 144 , 218 , 272 , 301 ] facial oedema (20–30 %), pressure ulcers around the face/cornea, pelvis, knee (approximately 20 %) [ 234 ] ‘intolerance’ while in the prone position (= coughing, compaction, respiratory problems approximately 20 %), cardiac dysrhythmias (approximately 5 %), necrosis of the mamilla, pressure ulcers of the tibial crest (individual reports), dislocations of the tracheal tube or venous/arterial lines (approximately 1–2 %) [ 105 ], nerve damage (two case studies regarding brachial plexus lesion [ 119 ]) (evidence level 2b). In this regard, it is necessary to consider that complications also occur in the supine position and a comparison of the incidences of position-related complications for the prone position has not previously been sufficiently studied.…”

Occult splenic rupture with cardiovascular collapse: a report of three cases in critically ill patients

“…The diagnosis is normally suspected from the history and symptoms of left hypochondriac pain radiating to the shoulder, it is also suspected from signs of abdominal swelling and hypovolaemia [2]. Rupture may also occur after iatrogenic trauma including CPR [8] and endoscopic procedures [9,10] or after minimal trauma, such as coughing, [3] vomiting [4,11] or the trauma associated with prone positioning in the treatment of adult respiratory distress syndrome [12]. The spleen may also rupture without any obvious trauma; pathological conditions that pre-dispose to this include infections, including infectious mononucleosis [6], and tropical diseases like malaria [7].…”