A 29-Year-Old Male with a Fatal Case of COVID-19 Acute Respiratory Distress Syndrome (CARDS) and Ventilator-Induced Lung Injury (VILI)

23 July 2020: Artilces

Unknown etiology, Challenging differential diagnosis, Management of emergency care

Smit S. Deliwala ^A* , Anoosha Ponnapalli ^A , Elfateh Seedahmed ^C , Mohammed Berrou ^C , Ghassan Bachuwa ^C , Arul Chandran ^A

DOI: 10.12659/AJCR.926136

Am J Case Rep 2020; 21:e926136

Table 1. Trends in oxygenation and ventilation.

Day of admission	Oxygen delivery	FiO2 (%)/flow rate (L/min)	Tidal volume (mL)	PEEP	Respiratory rate (breaths/min)	pH	PaO2	O2saturation (%)	PaCO2	HCO3	PaO2/FiO2 (PF) ratio	Radiographic findings	CARDS phenotype
Day 1	Nasal cannula	2L– 6L	N/A	N/A	28–32	N/A	N/A	90	N/A	29	N/A	Mild bilateral interstitial changes ()^{Figure 1}	Type L
Day 3	Non-rebreather	12L	N/A	N/A	34–47	N/A	N/A	90	N/A	23	N/A	Mild bilateral interstitial changes	Type L
Day 4	Volume control– Assist control	100	500	8	14	7.36	43	76.3	51	28.1	43	Interval worsening of airspace consolidation in the right mid and lower lung zone	Type L
Day 8	Volume control– Assist control	80	370	14	30	7.33	47	79.1	60	31.1	59	Bilateral extensive consolidated infiltrate concerning for multifocal pneumonia ()^{Figure 2}	Type H
Day 13	Volume control– Assist control	100	500	20	32	7.48	118	98.5	44	32.5	118	Worsening of bilateral infiltrates. Interval development of moderate size left pleural effusion	Type H
Day 17	Volume control– Assist control	90	420	18	26	7.30	60	87.2	82	39.2	67	Interval development of moderate tension pneumothorax in left mid/lower lung field with bilateral alveolar infiltrates ()^{Figure 3}	Type H
Day 18	Volume control– Assist control	100	450	18	32	7.38	68	92.9	61	35.1	68	Left pneumothorax with chest tube placed. Worse compared to prior with near collapse of the left lung. Left lung base consolidation	Type H