Abstract
A 48-year-old male was referred to the ICU for ARDS induced by infection of staphylococcus pneumonia. Chest X-ray and CT scans showed diffuse bilateral infiltrates and the P/F ratio after emergency intubation was 54. A poor arterial oxygenation prompted various postural drainage positions including prone position. On the second day, worsening conditions led us to perform manual breathing assist respiratory physiotherapy. A temporary P/F ratio improvement was observed. On the sixth day, rapidly worsening emphysema change appeared in chest X-ray, and was to suspect ventilator induced lung injury (VILI). Despite secession of the manual breathing assist method, deteriorating of the emphysema change led to patient worsening general condition and death on the ninth morning. We feel that performing the manual breathing assist respiratory physiotherapy on an acute phase of ventilator assisted ARDS patient is not in concordance with the pulmonary protection strategy of low volume ventilation. Therefore, a careful consideration of indication and method technique must be considered.
