20th February 2025

A 20-year-old man with a background of depression presents after a suicide attempt by hanging.

A 20-year-old man with a background of depression presents after a suicide attempt by hanging. He was found by police and, after a short period of bystander CPR, had return of spontaneous circulation. He was then transferred to the nearest hospital.

His initial ABG shows a lactate of 5.5 mmol/L (normal <2.0 mmol/L), which fell to 3.0 after a further 2 L of IV fluids. After CT of his head and neck, which were negative for any pathology, he was intubated, ventilated and transferred to the intensive care unit.

A few hours later, he developed increasing oxygen requirements. On examination, he had bilateral crepitations on auscultation of the lungs. His repeat lactate is 2.0. A chest radiograph was requested as shown below.

What is the most likely cause of his increasing oxygen requirements on the ICU? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.