In the early morning, an 84-year-old patient was admitted to ICU for severe dyspnea. It had been worsening for three days, no expectoration, no fever. Chest pain. The patient was admitted to ICU; non-invasive ventilation was started.
Patient´s history encompasses hypertension, chronic ischemic heart disease (state after coronary artery bypass surgery nine years ago) and Alzheimer disease.
Non-invasive ventilation continues (FiO2 0.5, PEEP 6, ASB 6 cm H2O), blood pressure 110/50 mmHg, sinus rhythm, 90 bpm, SpO2 96 %, auscultation revealed clear breathing with weakening at dorsobasal parts bilaterally.
Lab tests revealed neutrophile leucocytosis (24000, neutrophils 84 %), CRP 8 mg/l, procalcitonin 0.12 ng/ml, troponin T 32 ng/l, BNP 1950 pg/ml, D-dimers 700 ug/l, lactate 10 mmol/l, pH 7.2, BE -8 mmol/l.
Chest X-ray during admission:
Chest X-ray 3 hours after admission to ICU and insertion of the central venous catheter, non-invasive ventilation:
Ultrasonography was performed: