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Canadian Journal of Anesthesia, Vol 39, 963-965, Copyright © 1992 by Canadian Anesthesiologists' Society

ARTICLES

Pulmonary arteriovenous fistula: mechanical ventilation and hypoxemia

BC Friedman, BJ McGrath and JF Williams
Department of Anesthesia and Critical Care, George Washington University Medical Center.

Pulmonary arteriovenous malformation (PAVM) is an uncommon congenital anomaly. As PAVM is a direct communication between branches of the pulmonary artery and vein, major disturbances in gas exchange can result. We present a patient with an unsuspected PAVM who came to our institution for drainage of a brain abscess. Arterial blood gas analysis during and after surgery demonstrated a large alveolar-arterial gradient for oxygen in the absence of any obvious pulmonary pathology while the patient was receiving positive pressure ventilation (PPV). Oxygenation improved considerably upon resumption of spontaneous ventilation. A diagnosis of PAVM was made subsequently. We conclude that positive pressure ventilation can worsen right to left shunting in patients with PAVM.


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Am. J. Respir. Crit. Care Med., August 1, 1998; 158(2): 643 - 661.
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Copyright © 1992 by the Canadian Anesthesiologists' Society.