Intensive Care Management of COVID 19 Patient with Multiple Complications: Case Report
Hayriye Cankar Dal, Yasemin Altunel Yalnız, Muhammed Çobas, Nisan Taş, Sema Turan, Dilek Kazancı
SBU Ankara Şehir Hastanesi, Anesteziyoloji ve Reanimasyon
Giriş:
COVID19 was first seen at December 2019 in Wuhan, and has been spreading globally (1). Although pulmonary involvement is primarily in COVID19 also various complications can be seen during its course (2,3). With this report, we purpose to present the intensive care management (ICU) of a patient who developed ARDS, acute myocardial infarction (AMI) and intracranial hemorrage (ICH) during the follow-up.
Olgu: On the 1th of October 2020, 51-year-old man with a 10-day history of fever, dyspnea accepted to ICU with COVID19 pneumonia. He didn’t have any underlying medical conditions. Appropriate medical treatment with hydroxychloroquine, favipiravir, ceftriaxone was started. Because of the high levels of D-dimer enoxaparin(1mg/kg/12h) and acetylsalicylic acid added to treatment. On the 4thday of hospitalization patient had hypoxemic course despite maximum HFNO therapy than he was intubated. Acute phase reactants progressively increased; pulse steroid (10mg/kg) was added to therapy, cytokine filtration was done for 3 days. AMI developed at 6th day. Clopidogrel was added to the treatment with the recommendation of cardiology. After 10 days ICH was diagnosed and external ventricular drainage catheter inserted by neurosurgeon. In follow up patient was conscious. Percutaneous tracheotomy was done due to prolonged intubation duruation, After 2 weeks he was decanulated, On the 42nd day of ICU stay he was transferred to rehabilitation service. After 3 mounths he was discharged from service then he is completely back to his old healthy days.
Tartışma ve Sonuç: In this report, we present successful ICU management of a patient who developed COVID19 ARDS and had mortal complications such as AMI and ICH during follow-up. With this presentation, it was aimed to emphasize that COVID19 is not just a pulmonary disease, that mortal complications may develop due to COVID19 and also due to side effects of the applied treatments.
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