Acute white-out lung in mechanically ventilated patient

Abstract

ABSTRACT A 64-year-old male with a history of chronic kidney disease-5, type 2 diabetes mellitus (T2DM), and hypertension presented with syncope and weakness. Initial examination revealed a heart rate (HR) of 18/min and blood pressure (BP) of 140/90 mmHg. Intravenous (iv) atropine was administered, increasing HR to 85/min. Subsequently, the patient became pulseless, unconscious, and unresponsive, necessitating cardiopulmonary resuscitation (CPR) as per Advanced Cardiovascular Life Support (ACLS) protocol. Return of spontaneous circulation (ROSC) was achieved after three CPR cycles, and the patient regained consciousness. He was intubated and transferred to the intensive care unit. The patient, a smoker with a 4.5 pack-year history, experienced increased positive end-expiratory pressure (PEEP), elevated plateau pressure, and inadequate tidal volume generation a day later. Auscultation revealed significantly reduced air entry on the right side. Arterial blood gas (ABG) analysis indicated CO2 retention. Chest X-ray showed a white-out right lung, intercostal narrowing, and mediastinal shift toward the ipsilateral side.