Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (6)
The patient was discharged from the ICU on the 45th day; without respiratory symptoms and with a VC of 2.8 L. He left the hospital on the 65th day, with mild neurologic symptoms (paresthesia in both arms and legs). One year later, the findings from neurologic examination are normal, and no cardiac or infectious problem appeared while the patient was receiving the same immunosuppressive regimen.
This 42-year-old Egyptian man, who had been living in Switzerland for two years, suffered from dyspnea and ankle edema beginning four months before admission. He was examined, and a diagnosis of severe pulmonary arterial hypertension (mean pulmonary artery pressure, 65 mm Hg) associated with pulmonary fibrosis (surgical biopsy) was made. No cause could be found for this disease despite extensive screening, including parasitic and environmental factors. There was no left ventricular failure (capillary wedge pressure, 12 mm Hg; isotopic ventricular ejection fraction, 70 percent; and cardiac output, 6.2 L/min; however, insidiously, the P&C02 increased in this patient. Upon admission the PaC02 was 8.9 kPa (67 mm Hg) and after five days reached 11.5 kPa (86 mm Hg); the patient was hypoxemic and difficult to awaken.