Successful treatment of severe pneumonia, pyopneumothorax with severe acute respiratory distress syndrome, and septic sh
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European Journal of Medical Research Open Access
CASE REPORT
Successful treatment of severe pneumonia, pyopneumothorax with severe acute respiratory distress syndrome, and septic shock: a case report Xi Wang, Jian Lan*, Ruijie Zhang and Xiaoqing Luo
Abstract Background: This article reports a patient who survived severe pneumonia, pyopneumothorax with acute respiratory distress syndrome (ARDS), and septic shock, which is very difficult to treat. Case presentation: Antibiotics, continuous renal replacement therapy (CRRT), bronchial lavage and other treatments were used to treat a patient with pneumonia, pyopneumothorax, severe ARDS and septic shock. After comprehensive treatment, the patient was successfully treated and survived for a long time. Conclusions: There is a low successful clinical treatment rate for patients with pneumonia, pyopneumothorax with severe ARDS and septic shock. The successful treatment of this patient benefited from early and effective empirical therapy, targeted drug selection in the later stage, adequate closed thoracic drainage, repeated bronchial lavage, early CRRT, an appropriate respiratory support mode and parameter setting, immunotherapy and nutritional support therapy. This paper proposes a reference diagnosis and treatment solution for similar cases. Keywords: Severe pneumonia, Acute respiratory distress syndrome (ARDS), Septic shock, Continuous renal replacement therapy (CRRT), Mechanical ventilation Background According to recommendations from the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS), the main diagnostic criterion for severe pneumonia should be the need for invasive mechanical ventilation or the presence of vasoconstrictor-requiring septic shock. Severe pneumonia can induce ARDS. Severe ARDS can be diagnosed when the oxygenation index (OI) is lower than 100 mmHg (positive end expiratory pressure (PEEP) ≥ 5 cmH2O), leading to 46.1% hospital mortality [1]. For ARDS treated with mechanical ventilation, the incidence of pneumothorax is 6.5%, and *Correspondence: [email protected] The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
the mortality rate in that case is 51.4% [2]. Severe pneumonia may lead to sepsis and life-threatening organ dysfunction. ARDS associated with sepsis has a higher mortality rate than that with nonsepsis [3]. At present, there are no clinical guidelines for the treatment of severe pneumonia, pyopneumothorax with severe ARDS and septic shock. Studies have shown that early initiation of CRRT is associated with favorable clinical outcomes in ARDS patients [4]. We will share a successful case here. The present patient was critically ill, with a rapid progression of his condition. He was discharged from the hospital after receiving comprehensive treatment, including early CRRT, and has survived to this day.
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