Successful treatment of severe pneumonia, pyopneumothorax with severe acute respiratory distress syndrome, and septic shock: a case report

Abstract

Background: This article reports a patient who survived severe pneumonia, pyopneumothorax with acute respiratory distress syndrome (ARDS), and septic shock, which is very difficult to treat.

Case presentation: Antibiotics, continuous renal replacement therapy (CRRT), bronchial lavage and other treatments were used to treat a patient with pneumonia, pyopneumothorax, severe ARDS and septic shock. After comprehensive treatment, the patient was successfully treated and survived for a long time.

Conclusions: There is a low successful clinical treatment rate for patients with pneumonia, pyopneumothorax with severe ARDS and septic shock. The successful treatment of this patient benefited from early and effective empirical therapy, targeted drug selection in the later stage, adequate closed thoracic drainage, repeated bronchial lavage, early CRRT, an appropriate respiratory support mode and parameter setting, immunotherapy and nutritional support therapy. This paper proposes a reference diagnosis and treatment solution for similar cases.

Keywords: Acute respiratory distress syndrome (ARDS); Continuous renal replacement therapy (CRRT); Mechanical ventilation; Septic shock; Severe pneumonia.

Fig. 1

Series of bedside chest films: a A large quantity of left pleural effusions with inflammation of the right lung; b The left pleural effusion was partly absorbed while the encapsulated gas was added, and the shadow of the right lower lung mass became larger and thicker; c Pneumatosis occurred in the mediastinum, and an extensive accumulation of gas was found in both sides of the neck and under the skin of the chest wall; d The inflammation of both lungs was reduced, and the subcutaneous gas was basically absorbed

Fig. 2

Changes in the body temperature and anti-infective regimen during hospitalization

Fig. 3

Changes in the oxygenation index and inflammatory factors