PMC6715903_01
Representative Computed Tomography Scan of the lung after admission to the Intensive Care Unit. Interstitial infiltrates are indicated by asterisks.
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Computed tomography of the chest revealed bilateral small interstitial infiltrates (Fig. 1) while showing no signs of severe pneumonia.
Course of blood eosinophiles (given in percent relative to total leucocyte count) in weeks where time 0 corresponds to the event of intubation. Medication is noted in the graph at the time when administered. od: once daily, qid: four times a day.
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At time of admission, relative blood eosinophils were two percent (see Fig. 2, corresponding to 180 per mul absolute count). Due to the critical situation several applications of prednisolone within seven days (50 mg given four times per day, see Fig. 2) were applied in addition to inhalation of epinephrine, salbutamol/ipratropiumbromide every 15-30 minutes. The course of ventilatory parameters and eosinophils related to clinical course and the applied therapy regimen are also displayed in Fig. 2, Fig. 3. As had been expected, relative eosinophils dropped significantly after administering mepolizumab (Fig. 2).
Development of respiratory state with the parameters Carbon dioxide partial pressure (pCO2), inspiratory pressure of invasive ventilation (Pi) and pH-value over the course of time where time 0 corresponds to event of intubation. Medication is noted in the graph at the time when administered. qid: four times a day.
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fig3
At time of admission, relative blood eosinophils were two percent (see Fig. 2, corresponding to 180 per mul absolute count). The initial blood gas analysis during Biphasic Positive Airway Pressure-(BIPAP)-ventilation after intubation (settings: inspiratory pressure (Pi) 30 mmHg, expiratory airway pressure (PEEP) 10 mmHg, respiratory rate 26/min, inspiratory to expiratory time 1:2.6, and inspiratory oxygen concentration of 80%) showed a respiratory acidosis in arterial blood gas analysis: pH 7.117, carbon dioxide partial pressure (pCO2) 91 mmHg (see Fig. 3), oxygen partial pressure 202 mmHg, oxygen saturation 94%, bicarbonate 26 mmol/l, base excess 1.8, hemoglobin 7.8 g/l. BIPAP ventilation with Pi pressures up to 30 mmHg and various PEEP levels did not improve the respiratory situation. pCO2 increased up to 100 mmHg accompanied by an acidosis of pH 7.12 (Fig. 3). Regarding the clinical course, the respiratory situation improved considerably after two days with lower Pi pressures, an improved decarboxylation, pH normalization (see Fig. 3), and a decrease of the intrinsic PEEP to eight mmHg.