Mr. Shahadat Hussain Chowdhury, a 58 year old male with no known comorbidities like diabetes, hypertension or chest diseases presented to Aster Hospital, Mankhool with complaints of fever since two days associated with difficulty in breathing and mild cough. Initially, treated by Pulmonologist, Dr. Sandeep Pargi as idiopathic interstitial pneumonia with secondary lung infection. The patient received antibiotics and oxygen support for the same. Within 2 days of admission in the ward, the patient’s respiratory condition deteriorated acutely and was urgently shifted to the Critical Care Department for further evaluation and management.
In view of severe respiratory distress and very low oxygen percentage, the patient was initiated on non-invasive ventilation where in an oxygen mask of special make is put on the patient’s face and connected to mechanical ventilation. Even after 12 hours, his condition did not improve, hence was intubated and started on high oxygen support and high pressure ventilation. By now, the patient had gone into a dreadful syndrome called Acute Respiratory Distress Syndrome also called ARDS.
During his stay in the Critical Care Department, rigorous protocols and intensive ventilation strategies were performed on the patient as per the world ARDS network society. Special maneuvers like facedown ventilation also called as prone ventilation was initiated. During the course of the disease, the patient developed multi-organ failure like renal failure, cardiac compromise and liver dysfunction. All organ support was provided as per the Critical care Medicine protocols. By the 16th day, the patient could be weaned off from high dose medications and ventilator support. The tube from his lungs was removed and he started breathing on his own with minimal oxygen support using mechanical ventilator.
One of the known complications of ARDS and its therapy is critical care illness, muscle weakness and nerve involvement called polyneuromyopathy. During the evaluation of the disease by CT scan of the lungs and other tests, the diagnosis of interstitial lung disease was made. Hence, oxygen therapy as a baseline on regular basis was provided.
Though the patient has recovered from the acute phase of disease process, the long term prognosis remains poor in view of need for oxygen even at home and other places. The muscle weakness and nerve involvement would take longer duration to recover ranging from few weeks to months.
Statistics reflect that ARDS has a mortality rate of 45 – 70%. But in case of Mr. Shahadat Hussain the outcome is a reflection of evidence based medicine practice and rigorous protocols in critical care medicine for such sick patients.
Specialist Physician & HOD of Critical Care Medicine
Aster Hospital, Mankhool