37 yrs, Male patient pre morbid healthy admitted out side with complaints of Cough, Fever since 3 -4 days followed by Sudden onset of breathlessness since one day.
Patient transferred to VishwaRaj Hospital with aggrevation of above complaint.
Patient received at emergency room with Tachypnea, Tachycardia and Desaturation SpO2 – 70% on room air. Bilateral crepts present on auscultation with decreased air entry right lower zone.
Primary management done at ER with non invasive ventialator support ( BIPAP ). All required investigation such as X-Ray, ABG, Lab tests were done.
– ABG S/O Severe Respiratory Acidosis, X – Ray Chest suggestive of Extensive Bilateral Pneumonia
– Started on Broad Spectrum Antibiotics/Antivirals
– Patient becomes more Tachypnic & requires intubation and ventilatory support.
– Patient was not able to maintain oxygen saturation inspite of Intubation and ventilatory support.
– After Intubation – oxygen saturation and ABG analyisis done and decided to prone the patient.
– ABG S/O mixed acidosis with hypoxia. PH – 7.18, PcO2 – 71, Po2 – 61, HcO3 – 25.7
– Due to poor prognosis and worsening condition, patients relatives decided to seek a second opinion in Pune. However they finally agreed to continue treatment at VishwaRaj Hospital assured by the quality of healthcare services and
treatments available here.
– As per protocol Patient had given prone ventilation – 3 cycles.
– Close monitoring of the following parameter was done by our team of Intensivist and Infectious Disease specialist – Respiratory profile, DVT prophylaxis, enteral nutrition and neurological progress.
The patient could not drink liquids and had dysphagia due to Achalasia Cardia. The patient was advised surgery for the same. Traditionally this surgery is done with a large incision on the abdomen or through chest but due to newer technologies like laparoscopy it can be done with small (0.5 cm – 1 cm) incisions on the abdomen.
The patient underwent successful laparoscopic Heller’s myotomy at VishwaRaj Hospital by Dr Sushil Deshmukh, Laparoscopic
Surgeon and his team.
- - Identification of severe ARDS
- - Referral to Tertiary Institute
- - NIV ( Non Invasive ) as per tolerance
- - Invasive Ventilation & Lung protective Ventilation Strategy
- - Prone Ventilation - Recovery of patient and discharge
– Gradually improvement seen in X-ray chest and patient able to maintain oxygen saturation in supine position on Day 10.
– ABG S/O PH – 7.54, PCo2 – 23, Po2 – 107, HcO3 – 19.6
Dr Sushant Shinde
Dr. Sushant Shinde is a physician at VishwaRaj Super Speciality Hospital. Having more than 13 years of experience. Expert in Management of complicated Diabetes, Hypertension, Critical care Illness.
-
Dr. Vitthal Shendge
MBBS, DA, DNB HOD
Anesthesia -
Dr. Sachin Katkade
MBBS, DA
Anesthesiologist -
Dr. Kshitij Gaikwad
MBBS, DA
Anesthesiologist
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