Hirooka Yukinori, Ota Soichiro, Torizawa Noriko, Maekawa Chihiro, Yanagawa Youichi
Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, JPN.
Cureus. 2024 Jun 29;16(6):e63467. doi: 10.7759/cureus.63467. eCollection 2024 Jun.
A 72-year-old man with idiopathic pulmonary fibrosis (IPF) was on home oxygen therapy at 1 L/min. He fell approximately 3 m onto a concrete surface while painting the roof of his home and was emergently transported to a local hospital due to pain in his lower back and right lower limb. His initial Krebs von den Lungen level decreased with medical treatments but has shown an increasing trend over the past three respiratory outpatient visits. His other medical conditions, including dyslipidemia, lumbar pain, and allergic rhinitis, were treated with several drugs prescribed by a nearby clinic. At the previous hospital, an increased oxygen demand of around 5 L via mask was noted, although other vital signs were stable. A plain whole-body computed tomography (CT) scan revealed pulmonary edema, a fracture of the right femoral neck, and a fracture of the third lumbar vertebral body. During transfer to our hospital for surgery, crossing the Amagi Pass at an elevation of approximately 830 m, the patient's respiratory condition rapidly deteriorated. Upon arrival, the cardiac wall movement was hyperdynamic, and PaO was 29 mmHg under supplemental oxygen at 15 L/min, necessitating oral endotracheal intubation and initiation of mechanical ventilation. A chest CT scan showed worsening diffuse ground-glass opacities in both lungs compared to the previous CT scan at the referring hospital. Despite positive pressure ventilation with the mechanical ventilator, the patient's condition did not improve, and he died in the emergency room. Acute respiratory distress syndrome (ARDS) can occur following severe trauma but the onset of ARDS due to moderate trauma is extremely rare. Considering the possibility of an acute exacerbation of IPF prior to the injury, this report discusses the possibility of developing ARDS due to trauma-induced cytokines and lung damage from damage-associated molecular patterns, the possibility of inhaling dust while working on the roof, pneumonia caused by prescribed medication, viral infections, exposure to pollen and/or high altitude while passing through the mountain pass, and hypoxemia-inducing pulmonary edema.
一名72岁的特发性肺纤维化（IPF）男性患者正在家中接受1升/分钟的氧气治疗。他在家中粉刷屋顶时从约3米高处跌落到水泥地面，因下背部和右下肢疼痛被紧急送往当地医院。他最初的克雷布斯·冯·登·伦根水平经药物治疗后有所下降，但在过去三次呼吸门诊就诊时呈上升趋势。他的其他疾病，包括血脂异常、腰痛和过敏性鼻炎，由附近诊所开的几种药物进行治疗。在前一家医院，虽然其他生命体征稳定，但通过面罩吸氧需求增加至约5升。全身普通计算机断层扫描（CT）显示肺水肿、右股骨颈骨折和第三腰椎椎体骨折。在转往我院进行手术途中，经过海拔约830米的天城山口时，患者的呼吸状况迅速恶化。到达时，心脏壁运动亢进，在15升/分钟的补充氧气下，动脉血氧分压（PaO）为29毫米汞柱，需要进行气管插管并开始机械通气。胸部CT扫描显示，与转诊医院之前的CT扫描相比，双肺弥漫性磨玻璃影加重。尽管使用机械通气进行正压通气，但患者病情并未改善，最终在急诊室死亡。急性呼吸窘迫综合征（ARDS）可发生在严重创伤后，但中度创伤导致ARDS的情况极为罕见。考虑到受伤前IPF急性加重的可能性，本报告讨论了因创伤诱导的细胞因子和损伤相关分子模式导致的肺损伤而发生ARDS的可能性、在屋顶工作时吸入灰尘的可能性、处方药引起的肺炎、病毒感染、在通过山口时接触花粉和/或高海拔以及低氧血症诱导的肺水肿。
