Mechanical Ventilation Dependent in Ventilation Acquired Pneumonia and Susceptibility Pulmonary Fungal Infection of Hiv Patient: A Case Report

Iin Novita Nurhidayati Mahmuda, Evi Nurhayatun, R Satriyo Budhi Susilo, Dhani Redhono Harioputro, Arifin Arifin, Tatar Sumandjar

Abstract

Introduction: Patients with HIV infection who are treated in ICU are commonly diagnosed with respiratory failure. Ventilator-associated pneumonia (VAP) is complication of patients in the ICU and is one of the most common nosocomial infections. VAP encounters problems in many patients such as chronic ventilator dependence. Prolonged dependence on mechanical ventilation in patients suffer from profound impairment in physical function and/or cognitive status at the time of discharge and most require institutional care while increasing mortality in or after discharge from the hospital.

Case Illustration: A 45-year-old woman with stage 4 HIV, diagnosed in 2017, experienced numerous hospitalizations over the last 5 months. The patient is conscious, with BP 130/60mmHg, HR 92x/minute, RR 30x/minute intubated with SpO2 99% (Ventilator Spontaneous Mode Ps 8, PEEP 10, Tidale Volume 400-500mL FiO2 50%), temperature 36,8oC. Pulmo sound increased crepitation. Vancomycin antibiotics continued, ARVs continued, Cotrimoxazole continued, and Fluconazole was given. BGA evaluation results show a normal pH 7.45, PO2 102mmHg, PCO2 38mmHg, and lactate 1.3mmol/L. The patient eventually died of septic shock with her last sputum culture showing Acinetobacter baumanii.

Discussion: Among People Living with HIV (PLWHIV), the reason for mechanical ventilator could be due to AIDS-related respiratory disease. Pneumonia risk in PLWHIV is still higher than in other people without HIV infection despite HAART. Critically ill patients are at risk of mental stress when they require mechanical ventilation cause their ability to breathe depends on assistance from a machine. Patients repeatedly fail weaning attempts caused by weakened or deconditioned respiratory muscles through the presence of depressive disorder that might interfere with the pragmatics of weaning.

Conclusion: VAP is associated with high mortality and can result in ventilator dependence, particularly in immunocompromised patients. Only appropriate initial empiric antibiotic therapy is capable of remedying this critical situation, resulting in successful liberation from the ventilator.

Keywords: VAP, HIV infection, prolong mechanical ventilation, Sepsis

 

 


Keywords

VAP, , HIV infection, prolong mechanical ventilation, Sepsis

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References

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DOI: https://doi.org/10.20961/tscm.v1i2.79338

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