Recurrent Spontaneous Pneumothorax during the Recovery Phase of ARDS Due to H1N1 Infection

Year 2013, , 123 - 125, 01.01.2013

Canan Bor Kubilay Demirağ Mehmet Uyar İlkin Çankayalı Ali Reşat Moral

https://doi.org/10.5152/balkanmedj.2012.086

Abstract

The pregnant patients are prone to influenza A (H1N1) virus infection, which may rapidly progress to lower respiratory tract infection and subsequent respiratory failure and acute respiratory distress syndrome (ARDS). Pneumothorax might develop in ARDS under mechanical ventilation. But post-ARDS pneumothorax in spontaneously breathing patient has not been reported in the literature. We report a 31-year old pregnant woman infected with influenza A (H1N1) virus and progressed to ARDS. Mechanical ventilation with high PEEP improved patient's gas exchange parameters within 3 weeks. However spontaneous pneumothorax was developed one week after she weaned off the ventilator. After successful drainage therapy, the patient was discharged. However she re-admitted to the hospital because of a recurrent pneumothorax one week later. She was discharged in good health after being treated with negative continuous pleural aspiration for 10 days. Influenza might cause severe pulmonary infection and death. In addition to diffuse alveolar damage, sub-pleural and intrapulmonary air cysts might occur in influenza-related ARDS and may lead to spontaneous pneumothorax. This complication should always be considered during the recovery period of ARDS and a long-term close follow-up is necessary. Turkish Başlık: H1N1 Enfeksiyonundan kaynaklanan ARDS'nin iyileşme döneminde tekrarlayan spontan pnömotoraks Anahtar Kelimeler: H1N1 virüsü, Spontan Pnömotoraks, ARDS Gebeliği olan hastalar hızla alt solunumyolu enfeksiyonuna ilerleyebilen İnfluenza A(H1N1) enfeksiyonuna eğilimli olup bu enfeksiyonu takiben solunum yetmezliği ve ARDS gelişebilmektedir. ARDS hastalarında mekanik ventilasyon desteği altındayken pnömotoraks gelişebilmektedir. Ancak ARDS sonrasında, spontan solunumda gelişen pnömotoraks olgusu literatürde bildirilmemiştir. Tarafımızdan influenza A(H1N1) enfeksiyonu olan ve ARDS gelişen 31 yaşındaki gebe hasta bildirilmiştir. Yüksek PEEP değerlerindeki mekanik ventilasyon desteği hastanın gaz değişimlerinde üç hafta içinde iyileşme sağlamaktadır. Hastamızda spontan pnömotoraks ventilatörden ayrıldıktan bir hafta sonra gelişmiştir. Başarılı drenaj tedavisinden sonra hasta taburcu edilmiştir. Buna rağmen bir hafta sonra tekrarlayan pnömotoraks nedeniyle hastaneye başvurmuştur. Hasta sürekli negatif plevral aspirasyon ile 10 gün tedavi edildikten sonra sağlıklı şekilde taburcu edilmiştir. İnfluenza ciddi akciğer infeksiyonu ve ölüme neden olabilir. İnfluenza ilişkili ARDS'de diffuz alveolar hasara ilaveten sub-plevral ve intrapulmoner hava kistleri gelişebilir ve spontan pnömotoraksa neden olabilir. Bu komplikasyonun ARDS'nin iyileşme döneminde gelişebileceği düşünülerek uzun dönem izlem öngörülmelidir.

Keywords

H1N1 virus, spontaneous pneumothorax, ARDS

Recurrent Spontaneous Pneumothorax during the Recovery Phase of ARDS Due to H1N1 Infection

Abstract

References

• 1. Jamieson DJ, Honein MA, Rasmussen SA, Williams JL, Swerdlow DL, Biggerstaff MS, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009;374:451-8. [CrossRef]
• 2. Rello J, Rodríguez A, Ibañez P, Socias L, Cebrian J, Marques A, et al. Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)in Spain. Crit Care 2009;13:R148. [CrossRef]
• 3. Goognight WH, Soper DE. Pneumonia in pregnancy. Crit Care Med 2005;33:390-7. [CrossRef]
• 4. Turkish Ministry of Health (unpublished data) www.rsmh.gov.trwww.grip.gov.tr (19.1.2010)
• 5. Louie JK, Acosta M, Jamieson DJ, Honein MA;California Pandemic (H1N1) Working Group. Severe 2009 H1N1 influenza in pregnant and postpartum women in California. N Engl J Med 2010;362:27-35. [CrossRef]
• 6. Harper SA, Bradley JS, Englund JA, File TM, Gravenstein S, Hayden FG, et al. Seasonal influenza in adults and children--diagnosis, treatment, chemoprophylaxis, and institutional outbreak management:clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2009;48:1003-32. [CrossRef]
• 7. Gill JR, Sheng ZM, Ely SF, Guinee DG, Beasley MB, Suh J, et al. Pulmonary pathologic findings of fatal 2009 pandemic influenza A/H1N1 viral infections. Arch Pathol Lab Med 2010;134:235-43.
• 8. Catanzarite VA, Willms D. Adult respiratory distress syndrome in pregnancy:report of three cases and review of the literature. Obstet Gynecol Surv 1997;52:381-92. [CrossRef]
• 9. Jain P, Goswami K. Recurrent pneumothorax during pregnancy:a case report. J Med Case Rep. 2009;3:81.[CrossRef]
• 10. Wennergren M, Jorgensen C, Bugge M, Lepore V, Gatzinsky P. Pneumothorax in pregnancy. Acta Obstet Gynecol Scand 1990;69:441-2. [CrossRef]
• 11. Gattinoni L, Bombino M, Pelosi P. Lung structure and function in different stages of severe adult respiratory distress syndrome. JAMA 1994;271:1772-9. [CrossRef]
• 12. Bryant L, Morgan S. Chest wall, pleura lung, and mediastinum. In:Schwartz SI, Shires GT, Spencer FC, Storer EH, editors. Principles of surgery, 4th ed. New York, Toronto:McGrawHill;1984:675-7.
• 13. Chee CB, Abisheganaden J, Yeo JK, Lee P, Huan PY, Poh SC, et al. Persistent air-leak in spontaneous pneumothorax--clinical course and outcome. Respir Med 1998;92:757-61. [CrossRef]