Acute Crit Care.  2022 Feb;37(1):120-123. 10.4266/acc.2020.00983.

Successful noninvasive ventilation in a severely acidotic and hypercapnic comatose COVID-19 patient with multiple comorbidities: a case report

• Poonuraparampil JA
• Karim HMR
• Kesavankutty MP
• Nayak PP

• KMID: 2527915
• DOI: http://doi.org/10.4266/acc.2020.00983

Abstract

Effective use of noninvasive ventilation in patients with chronic obstructive pulmonary disease is well-known. However, noninvasive ventilation in patients presenting with altered sensorium and severe acidosis (pH <7.1) has been rarely described. Invasive mechanical ventilation is associated with high mortality in coronavirus disease 2019 (COVID-19), and use of noninvasive ventilation over invasive ventilation is an area of investigation. We report a case of COVID-19-induced acute exacerbation of chronic obstructive pulmonary disease in a 66-year-old male. His past medical history included obstructive sleep apnea, hypertension, cor pulmonale, atrial fibrillation, and amiodarone-induced hypothyroidism. On presentation, he had acute hypercapnic respiratory failure, severe acidosis (partial pressure of carbon dioxide [PCO2], 147 mm Hg; pH, 7.06), and altered mentation. The patient was successfully managed with noninvasive ventilation, avoiding endotracheal intubation, invasive ventilation, and related complications. Although precarious, a trial of noninvasive ventilation can be considered in COVID-19-induced acute exacerbation of chronic obstructive pulmonary disease with hypercapnic respiratory failure, severe acidosis, and altered mentation.

Keyword

chronic obstructive pulmonary disease, coma; COVID-19; noninvasive ventilation

Figure

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  Figure 1. (A) Mild ground-glass opacities left>right lung field with chronic obstructive pulmonary disease-related changes. (B) The arterial blood gas (ABG) parameters and (C) vital signs over time. NIV: noninvasive ventilation; pCO2: partial pressure of carbon dioxide; pO2: arterial partial pressure of oxygen; SaO2: peripheral oxygen saturation; HCO3: bicarbonate; ED: emergency department; ICU: intensive care unit; HR: heart rate; RR: respiratory rate; SBP: systolic blood pressure; DBP: diastolic blood pressure; SpO2: oxygen saturation as measured by pulse oximetry.

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