A patient suffering from COPD GOLD III was admitted to hospital for dyspnea. Influenza-A was diagnosed during the admission. Respiratory insufficiency appeared at the standard ward three days later. The patient was transferred to ICU. He was intubated. Lab tests revealed increasing levels of inflammatory markers. Antibiotic therapy was started after taking samples for microbiological tests. Haemodynamic instability appeared during the night.

In the morning: GCS 5, analgosedation, mechanical ventilation BiPAP, Pmax = 27, PEEP = 12, 12 breaths/minute, Ti:Te = 1, FiO2 0.5. Tidal volume around 500 ml. Sinus rhythm, noradrenalin 4 mg/h, blood pressure 74/40 mmHg. Peripheral parts of the body were cold, and capillaries did not refill. Oliguria 20 ml/h. Continuous administration of furosemide 20 mg/h. Auscultation revealed very silent breathing and rhonchi during expiration. Breathing could not be heard ventrally on the left side. Purulent sputum was evacuated.

Lab tests revealed decreasing levels of inflammatory markers. The nurses report impossibility of positioning the patient to his side due to worsening of haemodynamic instability.


Chest CT was suitable; however, haemodynamics had been assessed first using ultrasonography:


We started with lung ultrasonography since no breathing sounds could be heard on the left side:

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