Sykdommer
Acute respiratory distress syndrome?
man, 13/06/2011 - 23:52
Female (57) without significant past medical history, she visited my clinic at end of feb. 2011 because of high fever, sweating, lost appetite and sever dyspnosa at minimal exertion of 10 days duration, Her symtoms worsened significantly during these previous days.
During clinical examination, she was severely cyaanosed, shortness of breath at rest, high blood pressure, febrile (39,5 C), Spo2 at rest was 45 at rest without 02 supply, chest examonation showed bilateral decrease air entry and crackles.
Because of her clinical status we admitted her in ICU with urgent intubation and mechanical ventilator support, with significant improvement in general status and Spo2 (reached 95% within minutes). Her chest X-Ray shwed bilateral haziness.
With combined antibiotics and other medical treatments she responded to our treatment with disappearing of signs and lab. Findings of infection but she was totally dependent on ventilator becaus of extremely weak respiratory effort which mandates continuous mechanical ventilator.
After 4 weeks of herr disease course we tried extubation and it was successful and she remained on 02 therapy for 10 days but suddenly deteriorate from hospital acquired infection, we putted her again under mechanical ventilator.
During her stay in hospital her biochemical investigations were normal except from recurreent hypokalemia which was corrected accordingly by potassium infusion. Her repeated chest X-Rays showed lung homogenous opacities changing from left to right side by mucous plaque obstruction which removed twice through bronchoscopy. Chest CT Scan showed non conclusive findings.
As far as her other organ functions (heart, liver and kidney) were preserved in good way except respiratory effort which almost always dependant on mechanical ventilator (now on CPAP), she needs speecial respiratory care in a well developed respiratory center and by well trained personnel because chance of being ventilator dependant is high.Relevante sykdommer/medisiner: Help pleas, de haster.Kvinne, 57 år
Dear Sir,
Thank you for your case report of a female patient, age 57, with acute and severe respiratory disease.
The case you are presenting is lacking a diagnosis. As it is impossible to diagnose over the internet, my reply will be general in nature. It cannot replace a thorough clinical investigation, and I strongly recommend that your patient be under the clinical guidance of an experienced specialist in pulmonary disease. A second opinion from a seasoned pulmonologist is in order.
In general you are describing a 1) strong immune response (high fever, sweating) and a 2) severe dyspnea with cyanosis and x-ray findings in both lungs as well as low oxygen saturation 3) high blood pressure.
An infection was deemed to be the cause, and the patients (bacterial) pneumonia responded to treatment with antibiotics. According to your description, during her reconvalescence she acquired a new infection for which she now is under treatment. No other organs seem to be affected, which is very good news.
"Acute respiratory distress syndrome" - ARDS- can arise from a long list of causative agents. In recurring pulmonary illness one should be on the lookout for underlying disease which may pave the way for bacterial superinfections, such as viral infections, slow acting micro-organisms, cardiac illness, drug side effects/interactions, inhalation of noxious gases/smoke/illegal insecticides indoors (hotels, guest houses) to name a few. The link provided has more on ARDS.
Again, I strongly recommend getting a second opinion and clinical guidance from a specialist. I wish you and your patient the best of luck, and feel free to contact us again.
Kind regards,
Joe Siri Ekgren MD
Joe Siri Ekgren