Abstract
An 80-year-old woman developed acute respiratory distress syndrome from severe community-acquired pneumonia. Intermittent mandatory ventilation was initiated in association with administration of meropenem and sivelestat sodium hydrate. Since the P/F ratio decreased to 87 mmHg, the ventilation mode was changed to airway pressure release ventilation (APRV) with a continuous positive airway pressure (CPAP) phase of 27 cmH2O. While the P/F ratio increased to 230 mmHg 12 hours later, circulatory failure occurred, and the level of CPAP phase was lowered to 22 cmH2O. The patient developed disseminated intravascular coagulation on the 2nd disease day, and anticoagulant therapy with antithrombin and thrombomodulin was started. Thereafter, the P/F ratio was maintained at around 200 mmHg. Streptococcus pneumoniae fully sensitive to meropenem was indicated from a sputum culture sampled on admission. Inflammation and coagulopathy gradually improved. On the 7th disease day, the P/F ratio increased to more than 300 mmHg, and the patient was weaned from mechanical ventilation. APRV improved the pulmonary oxygenation to a certain degree but disturbed the circulation.
