Overcoming the Challenges of Prolonged Ventilation and Critical Illness Polyneuropathy in Severe ARDS Patients Due to Extensive Viral Pneumonia: A Case Report
Keywords:Acute Respiratory Distress Syndrome (ARDS), Ventilator-Associated Pneumonia (VAP), Oxygen Therapy, Critical Illness Polyneuropathy (CIP), Muscle Relaxant, Nebulization
ARDS is a life-threatening condition requiring intensive care unit monitoring. We present a 46-year-old male patient with ARDS and its complications, ventilator-associated pneumonia (VAP) and critcal illness polyneuropathy after extensive bilateral viral pneumonia. The objective of this case report is to understand better and manage the complications of ARDS. This study addresses ARDS and its complications, providing a comprehensive clinical understanding. It details a 46-year-old male patient’s case, treatment strategies, complications, weaning processes, and rehabilitation and emphasises the importance of physical therapy. This case report discusses the successful management and weaning of a patient with extensive viral pneumonia complicated with acute respiratory distress syndrome (ARDS), impending organ dysfunction, and critical illness polyneuropathy. The patient had a medical history of diabetes, hypertension, and dyslipidemia. Initial treatment involved oxygen therapy, nebulization, and empirical antiviral for seasonal flu. However, the patient required invasive ventilation with sedation and muscle relaxants following the ARDSNET protocol due to worsening respiratory status and extensive lung infiltrates. Secondary bacterial infections were also identified and treated accordingly. The weaning process was initiated but was complicated by re-intubation and the development of critical illness polyneuropathy. After successful weaning and recovery from ARDS and associated lung infections, physical therapy was provided for polyneuropathy regularly to overcome the manifest weakness all over the body muscles, including respiratory muscle weakness. The case report highlights the successful management of a patient with viral pneumonia, ARDS, and critical illness polyneuropathy, highlighting the importance of comprehensive treatment and physical therapy.
Abd-Elmonsef, M. M. E., Elsharawy, D., & Abd-Elsalam, A. S. (2018). Mechanical ventilator as a major cause of infection and drug resistance in intensive care unit. Environmental Science and Pollution Research, 25(31), 30787-30792. https://doi.org/10.1007/s11356-017-8613-5
Agudelo, C. W., Samaha, G., Garcia-Arcos, I. J. L. i. h., & disease. (2020). Alveolar lipids in pulmonary disease. A review, 19, 1-21.
Banavasi, H., Nguyen, P., Osman, H., & Soubani, A. O. J. T. A. J. o. t. M. S. (2021). Management of ARDS–What works and what does not, 362(1), 13-23.
Barbeta, E., Arrieta, M., Motos, A., Bobi, J., Yang, H., Yang, M., . . . Vargas, C. R. J. C. C. (2023). A long-lasting porcine model of ARDS caused by pneumonia and ventilator-induced lung injury, 27(1), 1-14.
Berend, K., & Duits, A. J. C. R. i. C. L. S. (2019). The role of the clinical laboratory in diagnosing acid–base disorders, 56(3), 147-169.
Bos, L. D., Martin-Loeches, I., & Schultz, M. J. J. E. R. R. (2018). ARDS: challenges in patient care and frontiers in research, 27(147).
Candan, S. A., Elibol, N., & Abdullahi, A. (2020). Consideration of prevention and management of long-term consequences of post-acute respiratory distress syndrome in patients with COVID-19. Physiotherapy Theory and Practice, 36(6), 663-668. https://doi.org/10.1080/09593985.2020.1766181
Determann, R. M., Royakkers, A., Wolthuis, E. K., Vlaar, A. P., Choi, G., Paulus, F., . . . Schultz, M. J. J. C. c. (2010). Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial, 14, 1-14.
Eisenhut, M., & Shin, J. I. J. F. i. P. (2020). Pathways in the pathophysiology of coronavirus 19 lung disease accessible to prevention and treatment, 11, 872.
Ferguson, N. D., Fan, E., Camporota, L., Antonelli, M., Anzueto, A., Beale, R., . . . Gattinoni, L. J. I. c. m. (2012). The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material, 38, 1573-1582.
Forel, J.-M., Voillet, F., Pulina, D., Gacouin, A., Perrin, G., Barrau, K., . . . Auquier, P. J. C. C. (2012). Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy, 16(2), 1-10.
Gosangi, B., Rubinowitz, A. N., Irugu, D., Gange, C., Bader, A., & Cortopassi, I. J. E. r. (2022). COVID-19 ARDS: a review of imaging features and overview of mechanical ventilation and its complications. 1-12.
Henderson, W. R., Chen, L., Amato, M. B., Brochard, L. J. J. A. j. o. r., & medicine, c. c. (2017). Fifty years of research in ARDS. Respiratory mechanics in acute respiratory distress syndrome, 196(7), 822-833.
Huppert, L. A., Matthay, M. A., & Ware, L. B. (2019). Pathogenesis of acute respiratory distress syndrome. Seminars in respiratory and critical care medicine,
Jin, C.-N., & Tang, L.-L. (2018). Muscle weakness associated with H7N9 infection: report of two cases. BMC Infectious Diseases, 18(1), 685. https://doi.org/10.1186/s12879-018-3592-9
Kallet, R. H., Branson, R. D., & Lipnick, M. S. J. R. C. (2022). Respiratory drive, dyspnea, and silent hypoxemia: A physiological review in the context of COVID-19, 67(10), 1343-1360.
Lucas, R., Hadizamani, Y., Enkhbaatar, P., Csanyi, G., Caldwell, R. W., Hundsberger, H., . . . Ash, D. J. F. i. p. (2022). Dichotomous role of tumor necrosis factor in pulmonary barrier function and alveolar fluid clearance. 12, 793251.
Michalski, J. E., Kurche, J. S., & Schwartz, D. A. J. T. R. (2022). From ARDS to pulmonary fibrosis: the next phase of the COVID-19 pandemic? , 241, 13-24.
Milacic, N., Kovijanic, Z., Bogojevic, M., & Milacic, B. J. S. (2018). Acute Respiratory Distress Syndrome as a Complication of Viral Pneumonia-Case Report. 13(1), 41-46.
Montealegre-Gómez, G., Garavito, E., Gómez-López, A., Rojas-Villarraga, A., & Parra-Medina, R. J. R. C. (2021). Colchicine: a potential therapeutic tool against COVID-19. Experience of 5 patients, 17(7), 371-375.
Morgan, A. J. S. (2021). Long-term outcomes from critical care, 39(1), 53-57.
Nowroozpoor, A., Malekmohammad, M., Seyyedi, S. R., & Hashemian, S. M. J. T. (2019). Pulmonary hypertension in intensive care units: an updated review, 18(3), 180.
Papazian, L., Klompas, M., & Luyt, C.-E. (2020). Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Medicine, 46(5), 888-906. https://doi.org/10.1007/s00134-020-05980-0
Peck, T. J., & Hibbert, K. A. J. F. (2019). Recent advances in the understanding and management of ARDS. 8.
Rittayamai, N., & Brochard, L. J. E. R. R. (2015). Recent advances in mechanical ventilation in patients with acute respiratory distress syndrome, 24(135), 132-140.
Rosenthal, V. D. (2016). International Nosocomial Infection Control Consortium (INICC) resources: INICC multidimensional approach and INICC surveillance online system. Am J Infect Control, 44(6), e81-90. https://doi.org/10.1016/j.ajic.2016.01.005
Taneja, R., Kapoor, R., Kashav, R., & Ramu, R. (2018). Successful management of severe acute respiratory distress syndrome caused by H1N1 viral pneumonia using early institution of extra corporeal membrane oxygenation therapy. International Journal of Research in Medical Sciences, 6, 1836. https://doi.org/10.18203/2320-6012.ijrms20181791
Trouillet, J.-L., Chastre, J., Vuagnat, A., Joly-Guillou, M.-L., Combaux, D., Dombret, M.-C., . . . medicine, c. c. (1998). Ventilator-associated pneumonia caused by potentially drug-resistant bacteria, 157(2), 531-539.
How to Cite
Copyright (c) 2023 Mohamed Elsammam Ahmed
This work is licensed under a Creative Commons Attribution 4.0 International License.