Table 1
ABG, Blood results, and ventilation of Case 1
| Admission | After ramping | 12 hrs | 24 hrs | Day 3 | Day 5 | |
|---|---|---|---|---|---|---|
| ABG* | ||||||
| PH | 7.15 | 7.28 | 7.46 | 7.43 | 7.42 | 7.41 |
| PCO2** (Kpa) | 16.9 | 10.9 | 7 | 7.1 | 7.5 | 7.4 |
| PO2 ***(Kpa) | 9.5 | 9.7 | 9.2 | 8.5 | 8.9 | 8.3 |
| HCO3**** | 30.8 | 31.3 | 33 | 31.8 | 32.2 | 32.4 |
| (mmol/l) | ||||||
| Lactate (mmol/l) | 1.1 | 0.9 | 1.3 | 1.5 | 0.8 | 1.1 |
| Ventilation | ||||||
| Oxygen delivery | NIV mask Drager Evita V800 | NIV mask Drager Evita V800 | NIV mask Drager Evita V800 | Nasal cannula | Nasal cannula | Room air |
| Ventilator mood | BIPAP | BIPAP | CPAP | |||
| Airway adjunct | Naso-pharyngeal | Naso-pharyngeal | Naso-pharyngeal | Natural | Natural | Natural |
| FIO2***** | 40% | 40% | 30% | 36% | 32% | 21% |
| PEEP****** (cmH2O) | 8 | 8 | 8 | |||
| Pressure support (cmH2O) | 23 | 23 | N/A | |||
| Actual tidal volume (ml) | 125 | 428 | 538 | |||
| Peek inspiratory pressure (cmH2O) | 42 | 24 | 23 | |||
| Respiratory rate | 42 | 28 | 22 | 20 | 18 | 17 |
| WOB scale | 6/7 | 4/7 | 2/7 | 1/7 | 1/7 | 1/7 |
| Blood results | ||||||
| Haemoglobin (g/l) | 172 | 165 | 170 | 168 | ||
| leukocytes (x10 g/l) | 13.2 | 11 | 7.8 | 8 | ||
| Platelets (x10 g/l) | 169 | 195 | 209 | 218 | ||
| C-Reactive Protien (mg/l) | 54 | 22.6 | 17.5 | 11.4 |
Fig. 1
Chest X-ray of Case 1: Bi-basal atelectasis and small bilateral pleural effusion.
Fig. 2
Chest X-ray of Case 2: Hazy opacification of both lungs’ mid and lower zones. Infection versus congestion.
Table 2
ABG, Blood results, and ventilation of Case 2
| Admission | After ramping | 12 hrs | 24 hrs overnight | Day 3 | Day5 | |
|---|---|---|---|---|---|---|
| ABG* | ||||||
| PH | 7.17 | 7.22 | 7.43 | 7.46 | 7.44 | 7.43 |
| PCO2** (Kpa) | 15.3 | 13.2 | 8.6 | 8.6 | 8 | 7.6 |
| PO2*** (Kpa) | 26.8 | 10.9 | 14.9 | 9.5 | 8.9 | 11.7 |
| HCO3**** (mmol/l) | 31.5 | 31.7 | 36.6 | 39 | 35.5 | 33.6 |
| Lactate (mmol/l) | 0.8 | 0.8 | 1.3 | 0.8 | 1.2 | 1.1 |
| Ventilation | ||||||
| Oxygen delivery | NIV mask Drager Evita V800 | NIV mask Drager Evita V800 | Face mask | NIV mask Drager Evita V800 | Nasal cannula | Room air |
| Ventilator mood | BIPAP | BIPAP | BIPAP | |||
| Airway adjunct | Natural | Natural | Natural | Natural | Natural | Natural |
| FIO2***** | 100 % | 60 % | 40% | 40 % | 24 % | 21% |
| PEEP****** (cmH2O) | 5 | 5 | 7 | |||
| Pressure support (cmH2O) | 25 | 25 | 14 | |||
| Actual tidal volume (ml) | 170 | 507 | 480 | |||
| Peek inspiratory pressure (cmH2O) | 39 | 26 | 27 | |||
| Respiratory rate | 38 | 29 | 22 | 18 | 20 | 22 |
| WOB scale | 6/7 | 5/7 | 2/7 | 1/7 | 1/7 | 2/7 |
| Blood results | ||||||
| Haemoglobin (g/l) | 118 | 106 | 112 | 116 | ||
| Leukocytes (x10 g/l) | 15.9 | 9 | 9.8 | 10.2 | ||
| Platelets (x10 g/l) | 368 | 302 | 299 | 296 | ||
| C-Reactive Protein (mg/l) | 76.2 | 52.8 | 26.7 | 26.2 |
Table 3
Medications for Case 1.
| Medication | Dose and route | Duration |
|---|---|---|
| -Co-amoxiclav | 1.2 g Intravenous twice daily | 3 days |
| -Clarithromycin | 500 mg Intravenous twice daily | 3 days |
| -Doxycycline | 100 mg Oral twice daily | 4 Days |
| -Pantoprazole | 40 mg Intravenous once daily | 5 days |
| -Prednisolone | 30 mg Oral once daily | 5 days |
| -Enoxaparin | 40 mg Subcutaneous once daily | 5 days |
| -Amlodipine | 5 mg Oral once daily | Regular medication |
| -Paracetamol | 1g Intravenous every 6 hours | 5 days |
| -Oxycodone | 2.5 mg Oral every 4 hours | 5 days as per request |
| -Salbutamol | 5 mg nebuliser every 6 hours | 5 days |
| -Ipratropium Bromide | 500 mcg nebuliser every 6 hours | 5 days |
Fig.-3
Case 2 on NIV lying on Oxford HELP pillow. The external auditory meatus (Line A) and the sternal notch (Line B) are aligned.
Table 4
Medications for Case 2.
| Medication | Dose and route | Duration |
|---|---|---|
| -Co-amoxiclav | 1.2 g Intravenous twice daily | 5 days |
| -Clarithromycin | 500 mg Intravenous twice daily | 5days |
| -Pantoprazole | 40 mg Intravenous once daily | 5 days |
| -Prednisolone | 30 mg Oral once daily | 5 days |
| -Enoxaparin | 80 mg Subcutaneous once daily | 5 days |
| -Furosemide | 40 mg Intravenous twice daily | 4 days |
| -Salbutamol | 5 mg nebuliser every 6 hours | 5 days |
| -Ipratropium Bromide | 500 mcg nebuliser every 6 hours | 5 days |
Fig. 4
Case 2 lying at 30 degrees up of the thorax. The external auditory meatus (line A) and the sternal notch (Line B) are not aligned.