Diagnostyka i leczenie zapalenia płuc związanego z terapią wentylacyjną – opis przypadku

*Marceli K. Łukaszewski, Grażyna Durek

Summary
Background.Intensive care in elderly patients with neurologic disease is strongly associated with ventilator-associated pneumonia (VAP). Endotracheal aspirate culturing may not always provide reliable results, and therefore bronchoscopic bronchoalveolar lavage (BAL) or protected specimen brush (PSB) should be considered.
Case report. An 80 yr-old male COPD patient was admitted to the ICU following a cardiac arrest. Cultures taken from the endobronchial aspirate revealed MRSA and candida albicans. The patient initially received ciprofloxacin and fluconazol. On the 5^th day, clinical signs of VAP (high fever, leucocytosis, purulent sputum) were observed. A mini-bronchoalveolar lavage (mini-BAL) was performed using a specially designed bronchial catheter and Pseudomonas aeruginosa was isolated. The infection was treated successfully with 14 days of piperacillin and tazobactam. The patient however, could not be weaned from the ventilator, and lateral spinal sclerosis was diagnosed.
Discussion. In the case described, the initial cultures taken from a routine endobronchial aspirate did not provide the correct diagnosis. The use of blind protected mini – BAL, as recommended by the American Thoracic Society 2004 guidelines allowed for the effective diagnosis and treatment of life-threatening pneumonia.

To jest tylko fragment artykułu. Aby przeczytać całość, przejdź do Czytelni medycznej.