Ventilator Weaning Failure Induced by Oral Beraprost in a Patient after Femoral Endarterectomy: A Case Report

Figures

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  Fig. 1. (A) Thoracic CT scan on hospital day 7 at the onset of respiratory failure, demonstrating bilateral ground-glass opacities and moderate pleural effusions. (B) Follow-up CT scan on hospital day 29 demonstrating a marked interval increase in pleural effusions, resulting in extensive compressive atelectasis. CT: computed tomography

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  Fig. 2. A comparison of composite 24-h SpO2 profiles during beraprost administration with those obtained after drug discontinuation during ventilator weaning. To visualize the daily recurrence of desaturation events, data from 28 consecutive days in each period were superimposed onto a single 24-h x-axis. Continuous SpO2 data (automatically recorded at 1-min intervals) were extracted from the electronic medical record and aggregated into 10-min averages using R software (version 4.3.3; R Foundation for Statistical Computing, Vienna, Austria) to reduce short-term noise and visually clarify diurnal trends. Light blue dots represent these averaged individual SpO2 measurements from all days within the specified period. The solid dark blue line represents the median (50th percentile), the shaded area represents the interquartile range (25th–75th percentile), and the dashed lines represent the 10th and 90th percentiles. (A) During beraprost administration and mechanical ventilation (hospital days 22–49), recurrent, severe, and nonphysiological desaturation episodes were observed. These episodes were frequently temporally associated with beraprost administration (arrows and vertical dotted…

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  Fig. 3. Timeline illustrating the patient’s clinical course. The upper section shows the major clinical events, level of respiratory support (blue graph), and dosage of beraprost sodium (red graph) over time, while the lower section displays serial chest CT images. Horizontal bidirectional arrows denote the “Fig. 2A period” (hospital days 22–49) and the “Fig. 2B period” (hospital days 50–77), linking the clinical timeline to the composite SpO2 data. After discontinuation of beraprost on hospital day 49, the level of respiratory support was gradually de-escalated. Coinciding with a single-dose rechallenge on hospital day 66, respiratory support was transiently increased. HD: hospital day; SBT: spontaneous breathing trial; TEA: thromboendarterectomy; Rt.: right; Lt.: left