48-jähriger Triathlet mit schwerer COVID-19-Pneumonie: erfolgreiche und sichere Behandlung mit Sauerstoff und CPAP

Zusammenfassung

Wir präsentieren den Fall eines 48-jährigen Patienten und Triathleten mit einer schweren COVID-19- und beidseitiger ausgedehnter Pneumonie. Der Patient präsentierte sich an Tag 7 seit Symptombeginn mit Fieber, Husten, Gliederschmerzen, progredienter Dyspnoe sowie einer schweren hypoxämischen Insuffizienz (PaO₂ 49,9 mmHg, PaCO₂ 35,7 mmHg, Horovitz-Index 130). In der CT des Thorax zeigten sich ausgedehnte beidseitige Milchglasinfiltrate. Formal waren die Kriterien eines ARDS nach Berlin-Definition erfüllt.

Es erfolgte entlang eines vorbestehenden definierten Behandlungskonzeptes zunächst eine Therapie mit Sauerstoff und nach zwischenzeitlicher Verschlechterung eine CPAP-Behandlung. Der Patient stabilisierte sich und konnte nach 12 Tagen stationärer Behandlung mit einer Normoxämie unter Raumluft entlassen werden. Belastbarkeit, Lungenfunktion und die CT des Thorax waren bei einer Nachuntersuchung 6 Wochen nach der Entlassung wieder normal.

Dieser Fall zeigt, dass auch bei einer schweren Hypoxämie infolge einer beidseitigen COVID-19 Pneumonie eine invasive Beatmung erfolgreich vermieden werden kann.

Abstract

We present the case of a 48-year old man, a triathlet, with severe COVID-19 and extensive bilateral pneumonia. On day 7 since onset of symptoms, the patient had fever, cough, rheumatic pain, dyspnea as well as severe hypoxemic respiratory failure (PaO₂ 49,9 mmHg, PaCO₂ 35,7 mmHg, Horovitz-Index 130). CT of the lung showed extensive bilateral ground glass opacities.

The patient was treated according to a predefined standard, including oxygen supplementation and, after intermittent worsening, with CPAP-ventilation. The patient improved and could be discharged with normal blood gases at ambient air after 12 days of hospitalization. Six weeks after discharge the patient was fully recovered and lung function as well as CT of the lungs were normal.

Our case demonstrates that invasive ventilation can successfully be avoided in patients with severe hypoxemia caused by COVID-19 with bilateral pneumonia.

Publication History

Received: 05 June 2020

Accepted: 15 June 2020

Article published online:
16 July 2020

• Literatur

• 1 Wu Z, Mcgoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19). JAMA 2020;
• 2 WHO Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected. Interim guidance. 2020 https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf Zugegriffen: 9. März 2020
• 3 Kluge S, Janssens U, Welte T. et al. Empfehlungen zur intensivmedizinischen Therapie von Patienten mit COVID-19. Med Klin Intensivmed Notfmed 2020; 115: 175-177
• 4 Phua J, Wenig L, Ling L. et al. Asian Critical Care Clinical Trials Group Intensive Care Management of Coronavirus Disease 2019 (COVID-19): Challenges and Recommendations. Lancet Respir Med 2020; 8: 506-5517
• 5 Alhazzani W, Møller MH, Arabi YM. et al. Surviving sepsis campaign: Guidelines on the management of critically ill adults with coronavirus disease. Crit Care Med 2020; 48: e440-e469
• 6 Zhou F, Yu T, Du R. et al. Clinical course and risk factors for mortality ofadult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054-1062
• 7 Wu C, Chen X, Cai Y. et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With CoronavirusDisease 2019 Pneumonia in Wuhan, China. JAMA internal medicine 2020;
• 8 Wang Y, Lu X, Chen H. et al. Clinical Course and Outcomes of 344 Intensive Care Patients with COVID-19. Am J Respir Crit Care Med 2020;
• 9 ICNARC. https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports 17.4.2020
• 10 Richardson S, Hirsch JS, Narasimhan M. et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA 2020; 323: 2052-2059
• 11 Rochwerg B, Brochard L, Elliott MW. et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017; 50: pii 1602426
• 12 Gattinoni L, Coppola S, Cressoni M. et al. COVID-19 Does Not Lead to a “Typical” Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2020; 201: 1299-1300
• 13 Gattinoni L, Chiumello D, Caironi P. et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes?. Intensive Care Med 2020; 46: 1099-1102
• 14 Winck JC, Ambrosino N. COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems. Pulmonology 2020;
• 15 NHS. Guidance for the role and use of non-invasive respiratory support in adult patients with COVID19 (confirmed or suspected) 6 April 2020, Version 3. 2020 https://www.england.nhs.uk/coronavirus/secondary-care/other-resources/specialty-guides/
• 16 Pfeifer M, Ewig S, Voshaar T. et al. [Position Paper for the State of the Art Application of Respiratory Support in Patients With COVID-19 – German Respiratory Society]. Pneumologie 2020; 74: 337-357
• 17 Sartini C, Treesoldi M, Scarpellini P. et al. Respiratory Parameters in Patients with COVID-19 after using Non-invasive Ventilation in the prone position outside the intensive care unit. JAMA 2020; 15: e207861
• 18 Köhler D. CaO2-Wert zur Beurteilung der Sauerstoff-Organversorgung: Klinische Bedeutung des Sauerstoffgehaltes. Dtsch Arztebl 2005; 102: A-2026/B-1711/C-1615
• 19 Edwards D, Man J, Brand P. et al. Inhaling to mitigate exhaled bioaerosols. Proc Natl Acad Sci U S A 2004; 101: 17383-17388