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Patient of interstitial lung disease has developed severe ARDS, developed body edema. Will intubation help recover?

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Posted on Wed, 13 Jun 2012
Question: My mother F/69 yrs, 4'11" and 70 kgs who is a patient of Interstital Lung Disease with PAH has developed severe ARDS and is presently on Bipap (present IPAP:EPAP settings 20/10) since 15 days.

However, since last 2 days her PaCO2 levels have gone to 134mm. SpO2 is 88% and PO2 is 66%. She is not able to react much apart from some pain.

She also has developed whole body edema and urine output is reduced with a creatine of 1.06 and a urea level of 111. Respiratory rate is 50.

Today she is on :
1. IV Effcolin (Glaxo) 100mg TDS
2. Azoran 50mg OD
3. Medrol 4mg OD
4. Bosantas 62.5 mg BD - Stopped today due to dropping hct levels
5. Sidenafil 20mg TDS
6. IV Albumin OD (SOS)
7. IV Pantocid 40mg OD
8. IV Actamase 2g BD
9. Lasix(Cipla) 20mg - BP Guided
10. Shecal OD
11. Aminophylline @ 10 microdrops/minute with DNS. Target heart rate = 100
12. K-Bind powder depending on Potassium levels
13. Moodalert BD

Doctor have advised to intubate her with little chance of recovery later.

Please advise ....as we are distressed and in urgent need of medical advise.

I am interested in reducing Blood PaCO2 through ECMO if possible
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Answered by Dr. Dinesh Goyal (8 hours later)
Hi XXXXXXX

Thank you for posting your query.

From the query posted, it appears that your mother is suffering from interstitial lung disease, which is a disease of lung parenchyma affecting the area in the lung where gases exchange take place.

You have not mentioned since how long she is suffering from this disease and what was her respiratory status before developing ARDS.

I presume that she must be in a hospital. As for as paco2 levels are concerned these are very high and are XXXXXXX These should be decreased to normal values as early as possible with any means like invasive ventilator or ECMO whatever is available in that hospital.

What i can see is that she is not in a condition to be shifted to any other center and if ECMO is not available in that hospital go ahead with intubation and mechanical ventilation, as you do not have any choice.

Increased carbon dioxide levels indicate an advance interstitial lung disease so prognosis will be poor. Keep trying

As far as medicines are concerned they are ok you’re treating physician is better judge ten me
Decreased urine output and high respiratory rate are all bad prognostic indicators.

Hope I have answered your query. Please write back to me if you have further queries.

Wish your mother an early recovery.

Regards.     

Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
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Dr. Dinesh Goyal

Pulmonologist

Practicing since :1994

Answered : 10 Questions

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Patient of interstitial lung disease has developed severe ARDS, developed body edema. Will intubation help recover?

Hi XXXXXXX

Thank you for posting your query.

From the query posted, it appears that your mother is suffering from interstitial lung disease, which is a disease of lung parenchyma affecting the area in the lung where gases exchange take place.

You have not mentioned since how long she is suffering from this disease and what was her respiratory status before developing ARDS.

I presume that she must be in a hospital. As for as paco2 levels are concerned these are very high and are XXXXXXX These should be decreased to normal values as early as possible with any means like invasive ventilator or ECMO whatever is available in that hospital.

What i can see is that she is not in a condition to be shifted to any other center and if ECMO is not available in that hospital go ahead with intubation and mechanical ventilation, as you do not have any choice.

Increased carbon dioxide levels indicate an advance interstitial lung disease so prognosis will be poor. Keep trying

As far as medicines are concerned they are ok you’re treating physician is better judge ten me
Decreased urine output and high respiratory rate are all bad prognostic indicators.

Hope I have answered your query. Please write back to me if you have further queries.

Wish your mother an early recovery.

Regards.