Sustained Mayer-Like Very-Low-Frequency Blood Pressure Oscillations in a 16-Year-Old After Drowning Associated Lung Injury

Abstract

Objective

To describe sustained, large-amplitude, Mayer-like very-low-frequency (VLF) oscillations in invasive arterial blood pressure following drowning-associated lung injury in an adolescent.

Design

Single-patient case report.

Setting

Pediatric intensive care unit at a tertiary medical center.

Patients

A previously healthy 16-year-old male.

Interventions

Mechanical ventilation for severe hypoxemia and pulmonary hemorrhage; vasopressor support with epinephrine; aggressive fluid resuscitation; bronchoscopy after cessation of bleeding.

Measurements and Main Results

Invasive arterial blood pressure monitoring demonstrated rhythmic oscillations with a periodicity of ∼28 s (≈0.036 Hz; ≈2.1 cycles/min) and amplitudes of 30–40 mm Hg. The pattern was not phase-locked to cardiac or ventilatory cycles, persisted for ∼12 h, and resolved before extubation. Noninvasive cuff readings corroborated the pattern, and discontinuation of epinephrine, replacement of the arterial line, tubing, transducer, and monitor did not change the oscillations.

Conclusions

Sustained, large-amplitude Mayer-like oscillations were observed after a severe hypoxic event in the setting of drowning-associated lung injury. The pattern likely reflects intense autonomic activation, plausibly amplified by catecholamine exposure and blood loss. Recognition may prevent misclassification as artifact or arrhythmia and may indicate heightened autonomic drive at the bedside.