Acute respiratory distress syndrome: Pulmonary and extrapulm
Case Reports
A 42-year-old female, a patient of dermatomyositis on oral immunosuppressive agents (60 mg/day of oral prednisolone and 100 mg/day of azathioprine), presented to the emergency department with a history of fever, dry cough, and breathlessness of 3-day duration. On examination, she had tachypnea and hypotension. Arterial blood gas analysis revealed hypoxemia. Imaging of the thorax (radiograph and computed tomography) revealed features of left mid zone consolidation with diffuse ground glass opacification [Figure 1]. A diagnosis of interstitial lung disease with severe community-acquired pneumonia with ARDS was considered. She was intubated and ventilated according to the ARDSnet protocol(low-tidal volume strategy) using the AVEA™ ventilator (CareFusion, Germany). After fluid resuscitation (target central venous pressure of 12 cm of saline and inferior vena cava collapsibility index <15–20%), vasopressors (noradrenaline and vasopressin) were added to maintain a mean arterial blood pressure of 65–70 mmHg. She was initiated on antibiotics, stress ulcer prophylaxis, and deep venous thrombosis prophylaxis. To facilitate ventilation, vecuronium was given as continuous infusion along with midazolam and fentanyl....