CHEST Guidelines-A-59-Year-Old-Man-With-ARDS-Receiving-“Prot

A-59-Year-Old-Man-With-ARDS-Receiving-“Prot

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The case report details a 59-year-old man with acute respiratory distress syndrome (ARDS) undergoing protective ventilation. He presented with symptoms of respiratory distress, including cough, fever, and breathlessness, which did not improve with prior antibiotic treatment. The patient had a history of hypertension, type 2 diabetes, and a long smoking history. Upon admission to the emergency department, he exhibited respiratory distress, significant hypoxemia, and required oxygen therapy. Initial treatment included antibiotics and oxygen, but he soon required mechanical ventilation and was diagnosed with ARDS.<br /><br />In the ICU, the patient was placed on assisted-controlled volume ventilation. Despite maintaining protective ventilation parameters, lung ultrasound revealed inadequate ventilation support. During spontaneous breathing efforts, a paradoxical worsening of aeration in nondependent lung zones (identified on ultrasound as pendelluft) occurred, indicating intrapulmonary gas transfer from nondependent to dependent zones, potentially causing overdistension and injury to those areas.<br /><br />The report emphasizes the utility of lung ultrasound in real-time monitoring of ventilatory support, revealing inadequacies not observed through clinical examinations or traditional respiratory mechanics. Despite appropriate tidal volumes, patient-triggered breaths led to harmful ventilation patterns.<br /><br />On ICU day three, the patient experienced worsened gas exchange, necessitating neuromuscular blockage and prone position ventilation. Unfortunately, he developed renal failure and died from multiple organ failure on ICU day six.<br /><br />The findings underscore the role of lung ultrasound in assessing regional lung responses and ensuring appropriate ventilation support in ARDS, warning against the potential harm from pendelluft during assisted spontaneous breathing efforts, even under protective ventilation strategies.

Keywords

acute respiratory distress syndrome

protective ventilation

lung ultrasound

mechanical ventilation

pendelluft

spontaneous breathing

ICU

ARDS

ventilatory support

multiple organ failure