Critical Care and Shock

Acute decompensated cor pulmonale: When holistic approaches meet early tracheostomy, a case report


Acute decompensated cor pulmonale is a clinical syndrome manifested by acute signs of severe congestive heart failure in chronic pulmonary disease with a high mortality rate. A patient with a history of uncontrolled bronchiectasis presented with generalized edema, severe shortness of breath, cardiogenic shock, and gradual loss of consciousness. Laboratory findings showed severe uncompensated respiratory acidosis and signs of infection. An echocardiography study showed signs of pulmonary hypertension with right ventricular (RV) dysfunction. Early tracheostomy in combination with the holistic approach (infection control, increased RV afterload prevention, RV contractility improvement, and RV preload optimization) were performed and were able to control the disease progression. This case report showcased the beneficial effect of early tracheostomy in managing acute decompensated cor pulmonale.