Two cases of acute respiratory distress syndrome associated with Legionella pneumonia successfully treated with permissive hypoxemia

Abstract

We report 2 cases of acute respiratory distress syndrome (ARDS) associated with Legionella pneumonia successfully treated with permissive hypoxemia. The patients were diagnosed as Legionella pneumonia with detection of urinary antigen of Legionella, and treated with intravenous levofloxacin. They were mechanically ventilated with a mode of pressure support ventilation. The first case was a 59-year-old male. The P/F ratio decreased to 64 because of severe pneumonia. The second case was a 64-year-old male. The P/F ratio decreased to 58. The PEEP level was set at 13-15 cmH₂O and the end-inspiratory plateau pressure was 22-25 cmH₂O in both cases. We induced permissive hypoxemia of SpO₂ 88% and PaO₂ 50 mmHg to set F_IO₂ 0.6-0.7 and to maintain airway pressure 25 cmH₂O or under as lung protective strategy. No hypoxic damage of any vital organs or progressive metabolic acidosis was detected. They recovered from severe ARDS without any residual dysfunction of vital organs.