24 February 2025
: Case report 
Severe COVID-19 Pneumonia, Opportunistic Candida krusei Infection, and Acute Respiratory Distress Syndrome with Pulmonary Arterial Hypertension Treated with Bosentan: A Case Report
Unusual clinical course, Management of emergency care
Killen H. Briones-Claudett
123ABCDEFG*, Killen H. Briones-Zamora 24ABCDEFG, Jaime Galo Benites Solis 34ACDEFG, Doménica I. Huilcapi Borja 4ABCDEFG, Karelys Nicole Arteaga Ocaña 4ABCDEFG, Maria Antonieta Touriz Bonifaz5BCDEFG, Pedro Barberan-Torres 1BCDEFG, Michelle Grunauer 6BCDEFG
DOI: 10.12659/AJCR.946400
Am J Case Rep 2025; 26:e946400
Table 2. Comprehensive pulmonary function analysis. Detailed assessment including spirometric parameters demonstrating restrictive pattern; body plethysmography confirming volume restrictions; diffusion capacity indicating gas exchange impairment; and cardiopulmonary exercise testing revealing exercise limitations and ventilatory inefficiency.
| Parameter | Unit | Pred. | Pre | %Pred | Post (L) | Post (%) | %Change |
|---|---|---|---|---|---|---|---|
| Forced vital capacity (FVC) | L | 3.80 | 2.85 | 75% | 3.00 | 79% | 5% |
| Forced expiratory volume in 1 second (FEV1) | L | 3.10 | 2.45 | 79% | 2.65 | 85% | 8% |
| FEV1/FVC ratio | % | 82 | 86 | 105% | 88 | 107% | 2% |
| Forced expiratory flow 25–75% | L/s | 3.00 | 2.10 | 70% | 2.40 | 80% | 14% |
| Peak expiratory flow | L/s | 7.50 | 6.80 | 91% | 7.10 | 95% | 4% |
| Total lung capacity (TLC) | L | 5.60 | 4.50 | 80% | 4.70 | 84% | 4% |
| Vital capacity (VC) | L | 3.90 | 3.00 | 77% | 3.15 | 81% | 5% |
| Residual volume (RV) | L | 1.85 | 1.80 | 97% | 1.75 | 95% | −3% |
| RV/TLC ratio | % | 33 | 40 | 121% | 37 | 112% | −7% |
| Functional residual capacity | L | 2.80 | 2.55 | 91% | 2.60 | 93% | 2% |
| Expiratory reserve volume | L | 1.30 | 0.90 | 69% | 0.95 | 73% | 6% |
| Inspiratory capacity | L | 2.60 | 2.10 | 81% | 2.20 | 85% | 5% |
| Parameter | Unit | Pred. | Pre | %Pred | Post | %Change | |
| Diffusing capacity for carbon monoxide (DLCO) | mL/min/mmHg | 30.0 | 21.0 | 70% | 22.5 | 7% | |
| Dlco adjusted for alveolar volume (DLCO/VA) | mL/min/mmHg/L | 4.80 | 4.00 | 83% | 4.20 | 5% | |
| Alveolar volume | L | 5.65 | 5.25 | 93% | 5.35 | 2% | |
| Transfer coefficient | mL/min/mmHg/L | 5.30 | 4.00 | 75% | 4.20 | 5% | |
| Parameter | Unit | Pred. | Max | %Pred | on AT | %Max | On RCP |
| Load | W | 125 | 111 | 89 | 73 | 66 | 65 |
| Heart rate | 1/min | 147 | 130 | 88 | 120 | 92 | 125 |
| Oxygen uptake (VO2) | ml/min | 1540 | 635 | 41 | 565 | 89 | 630 |
| Oxygen pulse (VO2/H) | ml/b | 10.5 | 4.88 | 46 | 4.71 | 97 | 5.04 |
| Carbon dioxide output (VCO2) | ml/min | 2002 | 494 | 25 | 494 | 100 | 477 |
| Respiratory exchange ratio | 1.00 | 0.81 | 81 | 0.78 | 96 | 0.76 | |
| Minute ventilation (VE) | l/min | 66.1 | 24.0 | 36 | 20.5 | 85 | 23.0 |
| Breathing frequency | 1/min | 16.5 | 20.8 | 126 | 16.5 | 79 | 18.5 |
| Systolic blood pressure | mmHg | 160 | 143 | 89 | 120 | 84 | 120 |
| Diastolic blood pressure | mmHg | 80 | 60 | 75 | 80 | 133 | 80 |
| Breathing reserve | % | 70 | 72.1 | 103 | 76.2 | 106 | 73.3 |
| Ventilatory equivalent for oxygen (VE/VO2) | 30.0 | 34.9 | 116 | 31.8 | 91 | 31.7 | |
| Ventilatory equivalent for carbon dioxide (VE/VCO2) | 30.0 | 47.8 | 159 | 44.1 | 92 | 44.5 | |
| Heart rate reserve | 1/min | 17 | 17 | 100 | 27 | 159 | 22 |