PMC7669217_01
Chest radiography: (A) without changes; (B) perihilar infiltrate and apparent middle lobe consolidation.
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On the initial chest X-ray, there were no changes (Figure 1A1). Seven days after the onset of symptoms, a new chest X-ray was performed (Figure 1B), with the presence of perihilar infiltrate and apparent middle lobe consolidation.
PMC7669217_02
Chest tomography: associated with suspected changes for viral pneumonia, there are extensive consolidations in the left inner lobe and a small pleural effusion (bacterial infection associated with COVID-19 pneumonia?).
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SpO2=80%, and immediate tracheal intubation was performed. Chest computed tomography compatible with the ground-glass standard was performed (Figure 2). SARS-CoV-2 testing was positive.
Chest radiography: (A) hypoexpanded lungs; (B) atelectasis of the right upper lobe and bilateral hypoexpansion; (C) hypoexpanded lungs.
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f3
In physical therapy, the maneuvers mentioned above were performed, as well as periods of non-invasive mechanical ventilation (NIMV), bilevel mode, IPAP = 14 cmH2O, EPAP=8 cmH2O, FiO2=40%, due to pulmonary hypoexpansion (Figure 3A), aspiration of airways, passive exercise evolving to assisted, stretching, and transfer training. A chest X-ray was performed (Figure 3B), showing atelectasis, and, besides the procedures described above, the MH technique with a self-inflating bag and HEPA filter (twice a day, three cycles of 10 repetitions each) was used to avoid aerosol dispersion. After three days, a chest X-ray was repeated with total resorption of atelectasis (Figure 3C), supplemental oxygen was removed, and the MH technique was suspended, with no need for airway aspiration.