Discussion on mechanical ventilation strategies for an obese patient with H10N3 avian influenza complicated with severe acute respiratory distress syndrome.
10.3760/cma.j.cn121430-20250514-00467
- Author:
Youling LI
1
;
Zhouhua XIE
;
Ping CEN
;
Sheng LIU
;
Ning LU
;
Shiji TAN
;
Yuming LU
;
Jing WEI
Author Information
1. Department of Critical Care Medicine, the Fourth People's Hospital of Nanning, Nanning 530013, China. Corresponding author: Wei Jing, Email: 391692750@qq.com.
- Publication Type:English Abstract
- MeSH:
Humans;
Female;
Influenza, Human/complications*;
Respiratory Distress Syndrome/complications*;
Respiration, Artificial/methods*;
Obesity/complications*;
Young Adult;
Extracorporeal Membrane Oxygenation;
Influenza A virus
- From:
Chinese Critical Care Medicine
2025;37(9):871-874
- CountryChina
- Language:Chinese
-
Abstract:
Avian influenza H10N3 is a type of avian influenza virus that can occasionally infect humans and cause severe pneumonia and acute respiratory distress syndrome (ARDS). On December 25, 2024, a 23-year-old obese female patient with H10N3 avian influenza complicated with severe ARDS was admitted to the Fourth People's Hospital of Nanning. The patient was transferred to our department due to "fever, cough, and shortness of breath for 13 days". Physical examination revealed moist rales in bilateral lungs. Chest imaging showed large areas of ground-glass opacity and consolidation in both lungs. Based on the patient's medical history, clinical manifestations, and laboratory findings, she was diagnosed with human infection of H10N3 avian influenza, severe pneumonia, and severe ARDS. Supported by mechanical ventilation and extracorporeal membrane oxygenation (ECMO), daily monitoring of airway peak pressure, plateau pressure (Pplat), driving pressure (ΔP), and lung compliance was performed to guide the adjustment of tidal volume (VT) and positive end-expiratory pressure (PEEP) during invasive mechanical ventilation. Medications including anti-avian influenza virus agents, antibacterial drugs, and antifungals were administered. Eventually, the patient's condition improved gradually, and she was successfully weaned from ECMO. No ventilator-induced lung injury (VILI) or multiple organ dysfunction syndrome (MODS) related to ARDS occurred during ECMO support. However, during the final stage of ventilator weaning after the restoration of spontaneous breathing, a right pneumothorax occurred. Closed thoracic drainage was performed, after which the ventilator was successfully discontinued. The patient was successfully transferred out of the intensive care unit (ICU), recovered fully, and was discharged from the hospital. In the invasive mechanical ventilation management of patients infected with H10N3 avian influenza complicated by ARDS, monitoring airway peak pressure, Pplat, ΔP, and assessing pulmonary compliance may facilitate more standardized management of such ARDS patients and help reduce VILI.
