Ng Mitchell K, Ngo Jason, Patel Anooj, Patel Drew, Ng Kenneth K
Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, USA.
Anesthesiology, Saint Barnabas Medical Center, Livingston, USA.
Cureus. 2020 May 21;12(5):e8228. doi: 10.7759/cureus.8228.
As of April 2020, the coronavirus 2019 (COVID-19) pandemic has resulted in more than 210,000 deaths globally. The most common cause of death from COVID-19 is acute respiratory failure. We report the case of a 78-year-old female with a history of hypertension, cerebrovascular accident (CVA), type 2 diabetes mellitus, and sarcoidosis, who presented to the emergency department with one day of dyspnea. The patient experienced a rapid decline in respiratory function and was intubated in the intensive care unit (ICU), meeting the Berlin criteria for severe acute respiratory distress syndrome (ARDS). Chest radiography revealed diffuse bilateral coalescent opacities, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA swab test was positive for COVID-19. The patient experienced acute kidney injury with uptrending creatinine levels and remained lethargic and unresponsive throughout her ICU stay, suggestive of potential hypoxic brain injury. In light of the patient's poor clinical status, age, and significant comorbidities, prognosis was conveyed about medical futility and patient's family agreed to terminal extubation and the patient expired peacefully, exactly one week from hospital admission. This case report highlights the speed at which severe ARDS can present and contribute to end-organ dysfunction in COVID-19 patients.
截至2020年4月，2019冠状病毒病（COVID-19）大流行已导致全球超过21万人死亡。COVID-19最常见的死亡原因是急性呼吸衰竭。我们报告一例78岁女性病例，该患者有高血压、脑血管意外（CVA）、2型糖尿病和结节病病史，因气短一天就诊于急诊科。患者呼吸功能迅速恶化，在重症监护病房（ICU）接受插管治疗，符合重度急性呼吸窘迫综合征（ARDS）的柏林标准。胸部X线检查显示双侧弥漫性融合性混浊，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）RNA拭子检测COVID-19呈阳性。患者出现急性肾损伤，肌酐水平不断上升，在整个ICU住院期间一直昏睡且无反应，提示可能存在缺氧性脑损伤。鉴于患者临床状况不佳、年龄较大且合并多种严重疾病，告知其家属治疗可能无效，患者家属同意终止通气，患者于入院整整一周后平静离世。本病例报告强调了COVID-19患者中重度ARDS出现的速度以及它对终末器官功能障碍的影响。
