Intermittent sudden dyspneic episodes.

Volume 87, Number 3 www.aafp.org/afp American Family Physician 217 A 62-year-old nursing home patient presented with dyspnea. He had recently been discharged from the intensive care unit after treatment for urosepsis with multiple organ failure. While in the hospital, he required vasopressors and mechanical ventilation for more than three weeks. After discharge to a skilled nursing facility, the patient had several episodes of acute respiratory failure. The episodes were sudden and self-limited, resolving rapidly with minimal intervention, such as nebulizers, supplemental oxygen, or head repositioning, and were associated with clear lungs on auscultation. The episodes occurred when the patient was recumbent with his head slightly elevated, or when he was sitting and reached forward. Imaging was performed (Figures 1 and 2).