Olivier Zerbib,Yaniv Hadi,Daniel Kovarsky,Gal Sahaf Levin,Tamar Gottesman,Mor Darkhovsky,Shaul Lev,
Multiple Recurrent Pneumothoraces and Thoracic Drain Insertion in a Mechanically Ventilated Patient Suffering from Methadone Induced Cardiomyopathy
Journal of Clinical and Medical Case Reports
2022
2733-2268
http://dx.doi.org/10.31487/j.JCMCR.2022.01.02
https://www.sciencerepository.org/multiple-recurrent-pneumothoraces-and_JCMCR-2022-1-102 
Abstract: Objective: To describe the experience of a multimodal therapeutic approach in a patient with methadone-induced dilated cardiomyopathy who developed recurrent bilateral tension pneumothorax.
Setting: Department of Intensive Care. 
Patient: A patient with methadone-induced cardiomyopathy and severe left ventricular dysfunction who after mechanical ventilation underwent bilateral tension pneumothorax and prolonged cardiovascular resuscitation (CPR).
Interventions: Cardiac Angiography, Multiple counter–shock (defibrillator dose), Multiple Thoracic Drains. 
Case Report: A 56-year-old man with past IV drug abuse and severe left ventricular dysfunction was transferred from the intensive cardiac care unit (ICCU) to our intensive care unit (ICU) ward due to suspected aspiration pneumonia. Multiple attempts of weaning off mechanical ventilation were unsuccessful, followed by development of septic shock. Following cardiothoracic consultation, two thoracic drains were placed. Due to repeated events of bilateral tension pneumothorax and CPR attempts, a total of seven thoracic drains were placed, permitting rapid control and improvement in the patient status. The possibility of Extracorporeal Membrane Oxygenation (ECMO) was not considered as supportive care due to methadone use and severe secondary cardiomyopathy. In the following days, control and stabilization of the patient status was obtained. Vasopressor treatment withdrawal, cessation of drainage and removal of five thoracic access points were successfully performed prior to percutaneous tracheostomy. The two remaining drains were removed later on during hospitalization. After 29 days in the ICU, the patient was discharged to a step down ward.Keywords: Methadone induced cardiomyopathy, severe left ventricular dysfunction, CPR, recurrent bilateral tension pneumothorax