Prone ventilation in a pregnant patient with scrub typhus-induced acute respiratory distress syndrome

2021 ◽  
Vol 14 (4) ◽  
pp. e242870
Author(s):  
Meenupriya Arasu ◽  
Nagalakshmi Swaminathan ◽  
Anusha Cherian ◽  
Magesh Parthiban
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Scrub Typhus ◽  
Febrile Illness ◽  
Pregnant Patient ◽  
Lung Compliance ◽  
Pcr Assay ◽  
Oxygenation Indices

A 23-year-old primigravida at 20 weeks of gestation presented to our hospital with undifferentiated febrile illness and severe acute respiratory distress syndrome. She was intubated in the emergency department and transferred to the intensive care unit. Initial treatment included ventilatory care, vasopressor support and broad-spectrum antibiotics. Based on a positive PCR assay for scrub typhus, she was treated with intravenous doxycycline and azithromycin. Despite reduction in fever, her oxygenation further declined. Following a risk–benefits assessment, we decided to ventilate her in prone position for 8 hours a day for three consecutive days using a checklist-based protocol. Her oxygenation indices and lung compliance markedly improved over this period, and she was extubated a day later. She was eventually discharged home after 1 week.

scholarly journals A case of scrub typhus presenting as ARDS

2019 ◽  
Vol 10 (3) ◽  
pp. 2014-2016
Author(s):  
Ahmed Siddique A ◽  
Jagadeesan M ◽  
Mariraj I ◽  
Ramkumar M ◽  
Prasanna Karthik S1 ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Clinical Presentation ◽  
Scrub Typhus ◽  
Central Nervous System Involvement ◽  
Febrile Illness ◽  
Interesting Case ◽  
Systemic Spread

Acute respiratory distress syndrome (ARDS) is a disease, mainly occurring in critically ill patients. The systemic spread of infections mainly causes ARDS due to the seepage of fluid in the spaces of the lung . Scrub typhus is a infection caused by . The bite of mite transmits it. Scrub typhus is frequently due to its non-specific clinical presentation and relatively low level of suspicion in treating physicians. The clinical presentation of scrub typhus is varied from fever, , rashes, headache, to pneumonia, acute respiratory distress syndrome, sepsis, central nervous system involvement. The disease is usually indistinguishable from other febrile illness like enteric fever, disease, malaria and certain viral hemorrhagic fevers. Identification of an points to the diagnosis without which the diagnosis is based on a high index of clinical suspicion. We report an interesting case of scrub typhus presenting as acute respiratory distress syndrome.

scholarly journals Risk factors of acute respiratory distress syndrome in Scrub typhus

2017 ◽  
Vol 5 (9) ◽  
pp. 3912 ◽  
Author(s):  
Karunya Jayasimha ◽  
Muralidhar Varma ◽  
Asha Kamath ◽  
Indira Bairy ◽  
Rahul Singh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
High Mortality ◽  
Distress Syndrome ◽  
Scrub Typhus ◽  
Early Recognition ◽  
Febrile Illness

Background: Scrub typhus is a common tropical infection presenting as acute febrile illness. Acute Respiratory Distress Syndrome (ARDS) is a serious complication of scrub typhus and is often associated with high mortality. This study was aimed to analyse risk factors of ARDS in Scrub typhus patients.Methods: This study was a prospective observational case control study conducted from June 2012 to June 2015 in Kasturba Hospital, Manipal, Karnataka, India. ARDS was diagnosed as per Berlin criteria.Results: During the study period, a total of 320 patients were diagnosed to have scrub typhus as per our criteria. All the patients were from state of Karnataka except for 1 patient, who was from state of Kerala. A total of 20 (6.25%) patients (cases) were diagnosed to have ARDS and 300 (93.75%) patients (controls) did not have ARDS. After multivariate analysis of the risk factors only two risk factors had significant association with development of ARDS: sepsis (OR 4.34,95% CI 0.51,36.76) and septic shock (OR 16.57 95% CI 1.64,166.76).Conclusions: ARDS is a common and serious complication of scrub typhus. It often occurs along with other complications. Presence of dyspnoea, sepsis, septic shock, hypoalbuminemia should alert clinicians about ARDS. ARDS due to scrub typhus is associated with high mortality. Early recognition and prompt therapy can reduce mortality.

scholarly journals Afebrile Scrub Typhus (Tsutsugamushi disease) with Acute Respiratory Distress Syndrome.

2002 ◽  
Vol 41 (8) ◽  
pp. 667-670 ◽  
Author(s):  
Koichi ICHIMURA ◽  
Yoshiko UCHIDA ◽  
Kunihiko ARAI ◽  
Kenji NAKAZAWA ◽  
Junichi SASAKI ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Scrub Typhus ◽  
Tsutsugamushi Disease

scholarly journals The Use of a Kinetic Therapy Rotational Bed in Pediatric Acute Respiratory Distress Syndrome: A Case Series

Children ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. 303
Author(s):  
Daniel T. Cater ◽  
Aimee R. Ealy ◽  
Erin Kramer ◽  
Samer Abu-Sultaneh ◽  
Courtney M. Rowan
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Case Series ◽  
Published Data ◽  
Arterial Line ◽  
Prone Positioning ◽  
Retrospective Case ◽  
Oxygenation Indices

Patients with acute respiratory distress syndrome (ARDS) commonly have dependent atelectasis and heterogeneous lung disease. Due to the heterogenous lung volumes seen, the application of positive end expiratory pressure (PEEP) can have both beneficial and deleterious effects. Alternating supine and prone positioning may be beneficial in ARDS by providing more homogenous distribution of PEEP and decreasing intrapulmonary shunt. In pediatrics, the pediatric acute lung injury and consensus conference (PALICC) recommended to consider it in severe pediatric ARDS (PARDS). Manually prone positioning patients can be burdensome in larger patients. In adults, the use of rotational beds has eased care of these patients. There is little published data about rotational bed therapy in children. Therefore, we sought to describe the use of a rotational bed in children with PARDS. We performed a retrospective case series of children who utilized a rotational bed as an adjunctive therapy for their PARDS. Patient data were collected and analyzed. Descriptive statistical analyses were performed and reported. Oxygenation indices (OI) pre- and post-prone positioning were analyzed. Twelve patients with PARDS were treated with a rotational bed with minimal adverse events. There were no complications noted. Three patients had malfunctioning of their arterial line while on the rotational bed. Oxygenation indices improved over time in 11 of the 12 patients included in the study while on the rotational bed. Rotational beds can be safely utilized in pediatric patients. In larger children with PARDS, where it may be more difficult to perform a manual prone position, use of a rotational bed can be considered a safe alternative.

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