Severe Legionella pneumonia successfully treated by independent lung ventilation with intrapulmonary percussive ventilation

Abstract

A case of severe Legionella pneumonia was successfully treated by independent lung ventilation (ILV) with intrapulmonary percussive ventilation (IPV). A 57-year-old man with lobar pneumonia was intubated and mechanically ventilated because of his deteriorating respiratory status. The diagnosis of Legionella pneumonia was made on the fourth day after admission and appropriate antibiotic therapy was commenced. On the fifth hospital day, ILV was commenced because the right unaffected lung was over-distended, his haemodynamic state was unstable and his left lung was producing copious amounts of purulent sputum. His right lung was ventilated and his left lung was treated with IPV owing to the existence of massive atelectasis. After treatment with antibiotics and ILV combined with IPV, his respiratory and haemodynamic status gradually improved. On the tenth day after admission, ILV was changed to conventional bilateral ventilation. The patient was extubated on the sixteenth hospital day and discharged from the intensive care unit 30 days after admission. The combination of ILV and IPV was therapeutically effective during the acute phase of unilateral severe Legionella pneumonia.