Abstract
The treatment strategy for acute respiratory distress syndrome (ARDS) requires the prompt removal of extravascular lung water index (ELWI) while controlling the progression of increased pulmonary vascular permeability (PVP). This report describes a patient who developed ARDS and survived due to successful early ventilator weaning, with the administration of the strict control of body fluid. PiCCO® (Pulsion Medical Systems, Germany) was used to monitor both ELWI and PVP. A 72-year-old female was admitted to another hospital because of acute respiratory failure and rapidly deteriorating oxygenation, after complaining of dyspnea a few days earlier. She was diagnosed to have acute respiratory failure caused by pneumonia. The patient was intubated and thereafter was transported to the ICU at Fukuoka University Hospital on the following day. ARDS was diagnosed based on the diffuse infiltrative shadow progressing rapidly in the bilateral lung fields, P/F ratio of 73, and a detailed hemodynamic assessment with PiCCO®. The patient was placed on mechanical ventilation and antibiotics, and sivelestat sodium was administered to control the increased PVP, which caused the increase of ELWI. The body fluid was also strictly controlled to maintain a euvolemic state. The PVP was normalized on the 3rd day and the increased ELWI thereafter gradually decreased. A chest radiograph disclosed a marked improvement of the diffuse infiltrative shadow in both lung fields on the 6th day and the P/F ratio improved to over 300. The patient was successfully weaned from the mechanical ventilation and could then be discharged from the ICU.
