The unpredictability of labile blood pressure: Afferent baroreflex failure in a critical patient with multiple thyroid surgeries and COVID-19 infection

Radiology Case Reports

article

Anas Mahmoud¹  Brooke Kania¹  Shady Geris¹  Wadah Akroush¹  Rajapriya Manickam¹  Moh'd Hazem K Azzam¹ 

[1] Department of Medicine, St. Joseph's University Medical Center

关键词: Afferent baroreflex failure;    COVID-19 pneumonia;    Head and neck surgery;    Thyroidectomy;    Labile blood pressure;   

DOI  :  10.1016/j.radcr.2022.11.030

学科分类：生物化学工程

来源: University of Washington * Department of Radiology

【 摘 要 】

The carotid sinus-arterial baroreflex is essential in maintaining blood pressure (BP) regulation. Afferent baroreflex failure (ABF) can present with labile changes in BP within seconds and can be secondary to neck surgery or radiation. We present here the first case, to our knowledge, of ABF precipitated by thyroidectomy, in a patient with active COVID-19 pneumonia, causing difficult control of severely labile BP in a critical care unit. Contributing factors included her critical illness state with upregulation of IL-6 leading to pituitary-adrenal axis alteration, her thyroidectomy further exacerbating autonomic dysfunction, as well as downregulation of ACE2 via COVID-19 infection. Management was achieved with a combination of midodrine and clonidine catered to specific BP thresholds. Additional research with a multidisciplinary approach is warranted to fully optimize the treatment of ABF in patients with neck surgery and or inflammatory conditions such as COVID-19.

【 授权许可】

CC BY|CC BY-NC-ND