48-jähriger Triathlet mit schwerer COVID-19-Pneumonie: erfolgreiche und sichere Behandlung mit Sauerstoff und CPAP

Zusammenfassung

Wir präsentieren den Fall eines 48-jährigen Patienten und Triathleten mit einer schweren COVID-19- und beidseitiger ausgedehnter Pneumonie. Der Patient präsentierte sich an Tag 7 seit Symptombeginn mit Fieber, Husten, Gliederschmerzen, progredienter Dyspnoe sowie einer schweren hypoxämischen Insuffizienz (PaO₂ 49,9 mmHg, PaCO₂ 35,7 mmHg, Horovitz-Index 130). In der CT des Thorax zeigten sich ausgedehnte beidseitige Milchglasinfiltrate. Formal waren die Kriterien eines ARDS nach Berlin-Definition erfüllt.

Es erfolgte entlang eines vorbestehenden definierten Behandlungskonzeptes zunächst eine Therapie mit Sauerstoff und nach zwischenzeitlicher Verschlechterung eine CPAP-Behandlung. Der Patient stabilisierte sich und konnte nach 12 Tagen stationärer Behandlung mit einer Normoxämie unter Raumluft entlassen werden. Belastbarkeit, Lungenfunktion und die CT des Thorax waren bei einer Nachuntersuchung 6 Wochen nach der Entlassung wieder normal.

Dieser Fall zeigt, dass auch bei einer schweren Hypoxämie infolge einer beidseitigen COVID-19 Pneumonie eine invasive Beatmung erfolgreich vermieden werden kann.

Abstract

We present the case of a 48-year old man, a triathlet, with severe COVID-19 and extensive bilateral pneumonia. On day 7 since onset of symptoms, the patient had fever, cough, rheumatic pain, dyspnea as well as severe hypoxemic respiratory failure (PaO₂ 49,9 mmHg, PaCO₂ 35,7 mmHg, Horovitz-Index 130). CT of the lung showed extensive bilateral ground glass opacities.

The patient was treated according to a predefined standard, including oxygen supplementation and, after intermittent worsening, with CPAP-ventilation. The patient improved and could be discharged with normal blood gases at ambient air after 12 days of hospitalization. Six weeks after discharge the patient was fully recovered and lung function as well as CT of the lungs were normal.

Our case demonstrates that invasive ventilation can successfully be avoided in patients with severe hypoxemia caused by COVID-19 with bilateral pneumonia.

Publication History

Received: 05 June 2020

Accepted: 15 June 2020

Article published online:
16 July 2020

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