Pulmonary Medicine


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Case Discussion

AIP/ARDS   Posted By Arpita    Date : 29-Jan-10   12:23 AM     Reply

My mom was admitted in Apollo, Kolkata on 4th Jan, 2010 with problem of nonstop coughing and mild fever. She was checked for H1N1 but was found -ve. So she was diagonosed with Viral Pneumonia and was treated for that. She was having hypoxemia and was on Oxygen Mask and Non Invasive Bipap for few days. She had almost recovered and was about to be moved out of ICU when she got a cross infection. Her O2 saturation levels dipped down and she was put on a ventilator. An HRCT scan was done and doctors found that there has been formation of fibrotic tissues in her lungs. Her chest was wet and same reflected in the Chest Xrays and HRCT as well. She was diagnosed with ARDS/AIP. The doctors decided to give her high dose of steroids (3 doses of 500mg). Following which her condition started to improve a bit. Her chest got clearer. It reflected in the Chest Xrays. Initially her PEEP pressure was still high at 12.5 while O2 requirement was 90%. Slowly the O2 requirements came down to 70% but PEEP was still high at 12.5. Since she was to be kept on Ventilator they decided to do a tracheostomy. Her PEEp immediately came to 11 after the Tracheostomy. In the next 4-5 days her ventilation requirements started to decrease. Her PEEP pressure was down to 6 and O2 requirement down to 55%. She was on Spontaneous mode (Pressure Support mose) for almost 40 hours. Her Pressure Support also came down from 28 to 25 to 23 to 18. A new HRCT scan was done which showed that the lungs have cleared. But the GGO was still the same. Soon the doctors decided to try Invasive Bipap for few hours. But then there was surgical emphysema due to which there was swelling in her left cheek. So they changed her Tracheostomy tube from 6 to 8. This resolved the swelling but due to lot of weight being put on the tube from outside the emphysema appeared again after 2 days and the tube had to be replaced again to 8.5. The emphysema reduced again with the tube change. The patient is otherwise haemodynamically stable. She has no temperature, BP or Sugar. All other organs are functioning normally. Currently the doctors have a divided opinion on her. While the Pulmonologist is hopeful and sees a recovery which is reflected in the reduced Ventilator parameters, but the physician sees not much improvement in the GGO and hence has a view that her lungs are still as stiff as they were initially. The steroids havent helped much. Her ventilator parameters are though improving day by day. Currently because of the tube change she is put on AC/PC mode with 60% O2 and 24/20 Preset Rate and 4 PEEP Pressure. Her O2 Saturation is 90+. She is comfortable even in the PS mode. Please suggest a course of action to us. Is there any specific medicine that helps in reducing the stiffness in the lungs? Is there any specific place where ARDS/AIP is treated properly? Also in case any of you wnat the details of the case please feel free to let me know. We have the detailed reports, Doctors comments and Xrays with us. I can mail the same to you. My contact details are as follows: Email: [email protected] Contact: 09038832675/ 09437075517 Thanks, Arpita

Replies to the above case discussion :

PNdxjnuhVSdM - James 23-Oct-12    04:09 AM

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