A patient was admitted to the ICU for respiratory failure, which developed due to atypical pneumonia. Influenza type B was the pathogen which caused a haemorrhagic manifestation of pneumonia in this patient. The patient needed non-invasive ventilation at first. Three days later, orotracheal intubation was necessary. Microbiology tests revealed superinfection by resistant E. coli. Antibiotic therapy was administered. Tracheostomy was established on the 10th day.
The patient has a history encompasses COPD, hypertension, chronic renal insufficiency, atrial fibrillation and chronic ischemic heart disease. He received coronary artery bypass graft (CABG) in 2006 and PCI with the two stent insertion into the left circumflex artery in 2007 and the next CABG in 2008.
He has been the 14th day in the ICU. Weaning from mechanical ventilation has already been started. The patient shows a good level of consciousness, needs minimal support of circulation by the administration of noradrenalin 0.4 mg/h. Antibiotic therapy has been finished. The tracheostomy tube is in place, and respiration is supported by CPAP/ASB, PEEP 8 cm H2O and FiO2 50%.
We can do more than only wait until the patient is ready for fully disconnection from mechanical ventilation. We can perform lung ultrasonography (LUS):