A patient was admitted to the department of internal medicine because of her cardiac decompensation. Later on, she was transferred to the ICU for worsening of dyspnea. We had to intubate the patient and start mechanical ventilation due to exhaustion and hypercapnia.

Continual administration of furosemide to achieve negative fluid balance and pleural puncture on the right side were performed due to the presence of significant bilateral effusion on the day of admission. Approximately 400 ml of amber fluid was evacuated. The gas exchange improved.

Ventilation worsened again on the next day. Chest X-ray revealed pneumothorax on the right side, and the chest drainage was established. Respiration slightly improved. The patient was haemodynamically stable without the necessity of administration of catecholamines. Lab tests revealed low values of inflammatory markers (leucocytes 11 000, CRP 18, procalcitonin 0.41). Administration of moderate doses of furosemide resulted in significant diuresis. Negative fluid balance was achieved.

The patient´s condition still required mechanical ventilation (BiPAP), Pmax 25, PEEP 10, FiO2 0.7, Ti:e = 1:1, tidal volume around 500 ml, frequency 16/min.


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