Key aspects in the treatment of severe community-acquired viral-bacterial pneumonia

Authors

  • O.M. Turkevych Danylo Halytsky Lviv National Medical University, Lviv, Ukraine; Clinical Emergency Hospital, Lviv, Ukraine
  • O.P. Zakotianskyi Danylo Halytsky Lviv National Medical University, Lviv, Ukraine; Clinical Emergency Hospital, Lviv, Ukraine
  • M.O. Harbar Danylo Halytsky Lviv National Medical University, Lviv, Ukraine; Clinical Emergency Hospital, Lviv, Ukraine

DOI:

https://doi.org/10.22141/2224-0586.16.6.2020.216521

Keywords:

respiratory therapy, community-acquired viral pneumonia

Abstract

Background. The high incidence of severe community-acquired pneumonias due to H5N1, A/H1N1, SARS, MERS and COVID-19 has attracted particular attention and has made us to revise and refine modern-day methods of treatment in the intensive care units. Objective: to analyze the main links of intensive care in the clinical case of severe community-acquired viral-bacterial pneumonia, to emphasize the main problems and suggest solutions. Materials and methods. We analyzed the clinical case of severe community-acquired viral and bacterial pneumonia in a 60-year-old patient, who was treated at the intensive care unit of Clinical Emergency Hospital in Lviv, and identified the main key aspects of intensive care: respiratory therapy, non-invasive ventilation, timely intubation, protective ventilation and the beginning of weaning; sedation, analgesia and muscle rela­xation; assessment of volemic status, infusion therapy and enteral nutrition. Results. The total duration of ventilation was 26 days. From day 16, the weaning process has been started, it lasted for 10 days. Main regimens of ventilation and their duration: SIMV-PC (8 days), BIPPV (7 days), CPAP + PS (10 days). We used dexmedetomidine for sedation du­ring 12 days. Non-invasive ventilation was not effective as evidenced by the deterioration of the patient’s condition after 24 hours of this respiratory support. We assessed volemic status in the critical period (first 48 hours after intubation) by ultrasonography of cardiac activity and condition of the main vessels, which proved to be very effective. Conclusions. Patients with severe community-acquired viral pneumonia require early onset of mechanical ventilation and mandatory protective strategy. Respiratory therapy, using protective strategy of ventilation, is a main part of treatment. One of the keys to success is adequate and comfortable sedation of patient. An ultrasound exa­mination allows for non-invasive assessment of volemic status, risk of pulmonary edema, and predicts the patient’s response to infusion therapy. We must perform a comprehensive ultrasound monitoring of the inferior vena cava, lungs, and heart in all critically ill patients who need infusion therapy and mechanical ventilation.

References

Griffiths M.J.D., McAuley D.F., Perkins G.D. et al. Guidelines on the management of acute respiratory distress syndrome. BMJ Open. Respir. Res. 2019, May 24. 6(1). e000420. doi: 10.1136/bmjresp-2019-000420.

Meng L., Qiu H., Wan L. et al. Intubation and Ventilation amid the COVID-19 Outbreak: Wuhan’s Experience. 2020 (https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2763453).

Raniery V.M., Rubenfeld D. еt al. Acute respiratory distress-syndrome: Berlin definition. JAMA. 2012. № 307(23). P. 2526-2533.

Cilloniz C., Ferrer M., Polverino E. еt al. Invasive mechanical ventilation in community acquired pneumonia. European Respiratory Jour-nal. 2014. 44. P. 4932.

Bellani G., Laffey J.G., Pham T., Brochard L. et al. Epidemiology, Patterns of Care, and Mortality for Patients with Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA. 2016. Vol. 315. № 8. P. 788-800.

Maltseva L.A., Mosentsev M.F, Bazylenko D.V. et al. Respiratory Distress Syndrome: Current Issues of Definitions, Clinical Presentation, Diagnostic Algorithm. Emergency Medicine. 2016. 4(75). https://doi.org/10.22141/2224-0586.4.75.2016.75827.

Maltseva L.A., Grishin V.I., Khalimonchyk V.V. et al. Preoxygenation: terminology, physiological basis, techniques, efficiency increasing methods, features in critical patients, possible risks. Emergency Medicine. 2018. 4 (91). P. 68-74. doi: 10.22141/2224-0586.4.91.2018.137860.

Wiedemann H.P., Wheeler A.P., Bernard G.R. et al. Comparison of two fluid-management strategies in acute lung injury. N. Engl. J. Med. 2006, Jun. 15. 354(24). 2564-2575. doi: 10.1056/NEJMoa062200.

Mackenzie D. Point-of-Care Ultrasound Masterclass. Volume Status and Fluid Responsiveness. Електронний ресурс: https://www.medmastery.com/shortcourse/assessing-fluid-tolerance

Уніфікований протокол надання медичної допомоги дорослим хворим на негоспітальну пневмонію: етіологія, патогенез, класифіка-ція, діагностика, антибактеріальна терапія та профілактика. Київ: Національна академія медичних наук України, 2016.

Хитрий Г.П., Левченко Т.М., Степанюк В.К. Сучасний погляд на респіраторну підтримку у хворих з вірусними пневмоніями. Про-блеми військової охорони здоров’я. 2012. С. 184-190.

Published

2020-09-01

Issue

Section

Case Study