Will bronchoscopy help to treat my uncle's collapsed lungs?

Question

Hi doctor,

My uncle has been admitted to a hospital after a week of high-grade fever along with a cough, which gradually increased. They took a chest x-ray and blood tests and confirmed that it is pneumonia, and my uncle was on oxygen (O₂). He was also suspected of having swine flu, and we waited for the reports, but gradually his lung function started diminishing. He showed pO₂ levels of 60 in arterial blood gas (ABG) at this time. But the computed tomography (CT) scan of the lungs depicted bilateral infection.

But the doctor treating him took it reluctantly and was waiting for the swine flu report. H1N1 was negative, yet his breathing became a major problem. All this happened in two days; on the night of the second day, he was almost closing his eyes with a fever of 101°F and partial pressure of O₂ (pO₂) levels of 54 in ABG. He was shifted to the intensive care unit (ICU) and was put on noninvasive ventilation (NIV).

The next morning, he did not improve, and his pO₂ levels were 45. So, we shifted him to a better hospital, which again put him in an isolated ward, suspecting H1N1, but diagnosed it as typical pneumonitis. All other parameters of his were normal, but he was put on a ventilator. Here, the H1N1 report was also negative, but the pulmonologist said that the pictures depict swine flu.

The team said that he is struggling on the ventilator too, but since all other vitals are stable, they promised us that he would recover slowly. On the ventilator, he showed pO₂ levels of 90, but the respiratory element in the monitor showed 25 to 35. He was on the ventilator for seven days; in between, they tried weaning, but he could not tolerate it. On the eighth day, he was extubated and put on NIV, fearing ventilator-associated pneumonia (VAP). He sustained for 24 hours in NIV with great difficulty, with diminishing pO₂ levels, and the respiratory element in the monitor rose to 40. During these 24 hours, he was extremely drowsy, and he did not respond to us.

He was restless and breathed with so much difficulty, but then the neurologist concluded that he was psychologically dull. After this, a tracheostomy was done, and he was intubated again. Now it is the third day he has been on the stoma. But yet he is in full artificial support now and not breathing naturally. A CT scan was taken yesterday, and I am attaching it.

Again, the doctors are suspecting swine flu, although the reports are negative. He is on high antibiotics, so the infection did not spread. But the lungs are full of scars, and he does not have a fever. We do not know where to go. Please help. He has not been on natural nutrition for nearly three weeks, so he is very tired. His muscles needed to be mobilized, so they thought of keeping him on the chair, but he couldn't. And today again he is on ventilation.

Today, the pulmonologist informed us that they plan to perform an endoscopy to remove some mucus. What is his condition? I am attaching all the reports that are available to me. Can I confirm if the CT reports taken two weeks ago now show any improvement? Will the endoscopy procedure help? Is there a better treatment available for the same condition? Will this viral pneumonia infection decrease? The doctors tell us that he is psychologically dull, and so he hesitates to breathe. What other things need to be done to make his atmosphere good?

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I have seen all the reports (attachment removed to protect patient identity) This history seems to be of acute viral pneumonitis, probably due to a new unknown strain or H1N1. The pO2 of 60 in the arterial blood gas(ABG) suggests of mild hypoxemia. Sometimes, cultures may be negative while he can still harbor it. The computed tomography (CT) scan is suggestive of ARDS (acute respiratory distress syndrome). When the respiratory system fails, it becomes very difficult to wean the patient off the ventilator.

Pulmonary rehabilitation can be sought once he is out of the ventilator. They might be doing a bronchoscopy and not an endoscopy. Yes, it will help in removing the mucus plug and reinflating the collapsed lung. The treatment is with higher antibiotics and antivirals like Tamiflu (oseltamivir phosphate). Sudden viral infections are very bad for a few people; nothing much can be done except for respiratory support.

I hope this helps.

Answer 2

Hi,

Welcome back to icliniq.com.

I have seen all the reports (attachment removed to protect patient identity). Yes, the reports show slight improvement. I hope he gets better; only time will tell. The infection has decreased, but the damage it has done to the lungs is too much; that is why he needs artificial support.

I hope this helps.