COVID-19 in a young man with hypertension: A case study of missed opportunities in intensive progression.
Kun Rao, Liuzhao Xie, Jianyu Wu and 3 others
PMID 32536516WHAT IT FOUND
A 41-year-old man with hypertension worsened after initial improvement, developing severe ARDS and needing mechanical ventilation.
The case describes missed opportunities, but it cannot show what caused the deterioration.
Key findings
01The patient deteriorated after initial improvement, developing ground-glass opacification in both lungs, severe ARDS and need for intubation.
02The patient received kaletra, oseltamivir, moxifloxacin, oxygen, irbesartan, bifid triple viable capsules, antipyretic therapy, teicoplanin, methylprednisolone, levamlodipine, sulperazone, ambroxol, acetylcysteine, meropenem, morphine sedation, noninvasive ventilation and mechanical ventilation, so the contribution of any single component cannot be separated.
03The authors report that enteral feeding was not initiated before or after mechanical ventilation, that no reliable fluid balance was reported, and that expectorant treatment was nebilised while unnecessary aerosol generation should be avoided in patients with COVID-19 without COPD or asthma.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a case report, so it cannot show whether any treatment helped or harmed the patient. The authors state that no causal relationships can be drawn because alternative explanations for worsening symptoms cannot be ruled out. Many medications, oxygen levels, ventilation settings and supportive treatments were given over time, so the contribution of any single component cannot be separated. The case says enteral feeding was not initiated before or after mechanical ventilation, and no reliable fluid balance was reported. The authors note that inflammatory mediator blood testing was not perfect and that some epidemic prevention and control factors were affected by lack of testing. The paper includes author speculation about immune state and virus removal as possible explanations for repeated positive nucleic acid tests.
Declared interests
The paper reports no funding source.
The easy way to misread this
Do not conclude that stopping irbesartan, switching antibiotics or not initiating enteral feeding caused the deterioration. This is a case report, many treatments were given, and the authors state no causal relationships can be drawn.