2020 年 11 巻 p. 116-120
Tashiro N, Sato T, Suzuki H, Kasai F. A case of acute aortic dissection with successful return to normal daily life following severe acute respiratory distress syndrome through continuous rehabilitation from the acute stage to the convalescent stage. Jpn J Compr Rehabil Sci 2020; 11: 116-120.
A 70-year-old male with back pain presented to the hospital for Stanford type B acute aortic dissection. Treatment was initiated using rest and a combination of antihypertensive drugs and analgesics. On day 2 of hospital stay, he developed hypoxemia and was diagnosed with acute respiratory distress syndrome (ARDS). On day 4 of hospital stay, PaO2/FiO2 (P/F ratio) of 124.7 indicated persistence of hypoxemia and physical therapy was initiated. Prone positioning therapy for 11―16 hours per day was performed continuously for four days. On day 7, his P/F ratio was maintained at ≥300. Image findings also indicated improvement. On day 10, he was weaned off the ventilator and began meals and ambulation. On day 12, his grip strength (right/left) was 26.8/25.5 kg, quadriceps muscle strength (right/left) was 0.22/0.19 kgf/kg, Medical Research Council (MRC) score was 56, and Functional Status Score for the Intensive Care Unit (FSS-ICU) was 28. He was therefore discharged from the ICU. His exercise load was gradually increased in stages while maintaining his systolic blood pressure at ≤140 mmHg. On day 37, he was able to walk with a cane and ascend/descend stairs. Therefore, he was transferred to the rehabilitation hospital. On day 65 of hospital stay, he was able to walk and stand without mechanical assistance. His grip strength was 34.0/33.0 kg, quadriceps muscle strength was 0.48/0.49 kgf/kg, MRC score was 60, FSS-ICU score was 35, and six-minute walking distance was 342 m, indicating satisfactory recovery of functions, and therefore he was discharged home.
