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Lung India Official publication of Indian Chest Society  
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CASE REPORT
Year : 2010  |  Volume : 27  |  Issue : 1  |  Page : 24-26

Phlebotomy for rapid weaning and extubation in COPD patient with secondary polycythemia and respiratory failure


1 Department of Internal Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, India
2 Department of Cardiology, Kalinga Institute of Medical Sciences, Bhubaneswar, India

Correspondence Address:
Swagata Tripathy
Department of Anesthesia and Intensive Care, Kalinga Institute of Medical Sciences, Patia, Bhubaneswar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-2113.59264

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The increased incidence of ventilator-associated complications in patients with chronic obstructive pulmonary disease (COPD) necessitates rapid weaning and extubation. The presence of secondary polycythemia in this subgroup increases the incidence of stroke and myocardial infarction due to hyperviscosity and tissue hypoxia. We present a 58-year-old male patient of COPD with secondary polycythemia (hematocrit 64%) who had possible hyperviscosity-related complications leading to cardiac arrest after a minor surgical procedure. The patient developed ventilator dependence after recovery. Phlebotomy was done to remove 10% of total blood volume. Symptomatic improvement was dramatic. Improvement in weaning indices like rapid shallow breathing index and PaO 2 /PAO 2 was observed facilitating rapid weaning and early extubation. Monitored, acute phlebotomy is safe and cost-effective. It decreases blood volume and viscosity, increases cardiac output and improves exercise tolerance in patients.


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