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

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

Öz

Kaynakça

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