ArticleCureus2025
Pulmonary Electrical Injury: A Case Report on an Uncommon Cause of Refractory Hypoxemia.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Pulmonary involvement after high-voltage electrocution is rare and may present with hypoxemia and pulmonary hypertension out of proportion to imaging, suggesting a vascular/endothelial mechanism. The objective of this report is to describe a case of disproportionate hypoxemia with severe pulmonary hypertension after electrocution, highlight diagnostic pitfalls, and outline management implications. A previously healthy 46-year-old man sustained high-voltage electrocution, required prolonged resuscitation, and developed severe hypoxemia (PaO₂/FiO₂ (ratio of arterial oxygen partial pressure to fractional inspired oxygen): 68) despite protective ventilation and proning. CT showed only mild posterior ground-glass change; echocardiography revealed preserved right ventricular function. On ICU day 4, a CT pulmonary angiogram (CTPA) identified very distal subsegmental pulmonary embolism. Pulmonary artery catheterization documented pulmonary hypertension (pulmonary artery pressure (PAP): 68/39 mmHg; mean ≈49 mmHg), high/normal cardiac index (4.19 L/min/m²), and mildly elevated pulmonary vascular resistance. Despite prone positioning (FiO₂ 1.0, positive end expiratory pressure (PEEP) 8 cm H₂O, tidal volume (Vt) ~6 mL/kg predicted body weight (PBW)) and neuromuscular blockade, hypoxemia persisted. Inhaled vasodilators and veno-venous extracorporeal membrane oxygenation (VV-ECMO) were not available at our center. The patient progressed to multiorgan failure and died. Electrocution may precipitate a primary pulmonary vascular phenotype with physiology that outpaces imaging. Early hemodynamic assessment can refine diagnosis and escalation. Where available, time-limited trials of inhaled vasodilators and timely consideration of VV-ECMO are reasonable.
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