Summary
Due to excessive calcification, my dad went thru aortic valve replacement (new value is a tissue valve ). He has had a long stay in the Intensive Care because of respiratory problems. He gets respiratory spasms (i.e. breatlessness ) and has to be put back on ventillator. There is fluid accumulation in his lungs and excessive secretion in his lungs. He is unable to cough out the secretions. Due to long ICU stay, his respiratory muscle is weaker than what it was before surgery.
Patient is a non smoker, is not diabetic, did not have any lung disorders before surgery.
Current Problem (as identified by pulmonologist)
1. State of Hypoalbuminenia (refers to swelling all over his body. This is due to lack of protien and is less of a problem as I understand)
2. Generalized motor weakness (waker muscles because he has been on bed for 2 months)
3. Non resolving lung shadows (suspecting Fibroproliferation stage of AL1). This could be reason behind breathlessness..need to confirm)
4. High ventilatory requirements (F1O2 50 percent)
Patient has been for prolonged period on antibiotics
Suggestions (by pulmonologist)
1. Repeat HRCT Thorax to look for Fibroris
2. Repeat Bronchoscopy
(last time, bronchoscopy was done 4 weeks ago. And pus cells were found. Antibiotics were administered in line with the c/s test)
3. Change antibiotics that have been going on for last 15 days (i.e. the broad range antibiotics) to:
- doispenem
- colistin Neb
- sulbactum + ampicillin
- ct. limid
4. Send blood for Galactomannan
5. Change hydrocotizone to solumednol (40 mg IV TAS)
6. Empirical antifungal therapy (Caspofungin)
7. Methycobal injection OD 1M
CT Scan of the chest (21 May) - Report
The study reveals multiple confluent areas of consolidation, alveolar opacities and mild smooth interlobular and intralobular septal thickening seen involving almost all lobes bilateral lung parenchyma, more marked in the upper lobes. There are small patchy areas of interspersed lung parenchyma seen as well
There is mild bilateral pleural effusion seen, more on right side.
No significant mediastinal or hilar adenopathy is seen
Mediastinal fat planes appear clean
Minimal pericardial effusion is seen
There is minimal retrosternal collection seen with sternal sutures in situ.
Need suggestions on:
1. Is the respiratory problem not curable ? Despite broad range antibiotics, this problem is still at large. His blood gases test when he goes off the
ventilator show increasing levels of CO2 and dropping levels of O2. And there is fluid accumulation in his lungs. Another symptom is of excessive secretions in his lungs.
The secretions are not drying for good despite antibiotics).
Patient keeps coming back to ventilator because of these reasons.
2. Heart surgeon repeatedly claims that the new heart and valve are functioning ok. EF is 60 , which is good. Heart echo did not find any issues.
But Pulmonologist clarified that the respiratory problems started
only after surgery and that a comparison of tests conducted before and after the surgery prove this. Other sources mentioned that the change in physiology due to heart surgery resulted
in back pressure on lungs and that is why lungs have fluid accumulation. Anyone has suggestions on the root cause of this problem. And how this could be fixed.
Due to excessive calcification, my dad went thru aortic valve replacement (new value is a tissue valve ). He has had a long stay in the Intensive Care because of respiratory problems. He gets respiratory spasms (i.e. breatlessness ) and has to be put back on ventillator. There is fluid accumulation in his lungs and excessive secretion in his lungs. He is unable to cough out the secretions. Due to long ICU stay, his respiratory muscle is weaker than what it was before surgery.
Patient is a non smoker, is not diabetic, did not have any lung disorders before surgery.
Current Problem (as identified by pulmonologist)
1. State of Hypoalbuminenia (refers to swelling all over his body. This is due to lack of protien and is less of a problem as I understand)
2. Generalized motor weakness (waker muscles because he has been on bed for 2 months)
3. Non resolving lung shadows (suspecting Fibroproliferation stage of AL1). This could be reason behind breathlessness..need to confirm)
4. High ventilatory requirements (F1O2 50 percent)
Patient has been for prolonged period on antibiotics
Suggestions (by pulmonologist)
1. Repeat HRCT Thorax to look for Fibroris
2. Repeat Bronchoscopy
(last time, bronchoscopy was done 4 weeks ago. And pus cells were found. Antibiotics were administered in line with the c/s test)
3. Change antibiotics that have been going on for last 15 days (i.e. the broad range antibiotics) to:
- doispenem
- colistin Neb
- sulbactum + ampicillin
- ct. limid
4. Send blood for Galactomannan
5. Change hydrocotizone to solumednol (40 mg IV TAS)
6. Empirical antifungal therapy (Caspofungin)
7. Methycobal injection OD 1M
CT Scan of the chest (21 May) - Report
The study reveals multiple confluent areas of consolidation, alveolar opacities and mild smooth interlobular and intralobular septal thickening seen involving almost all lobes bilateral lung parenchyma, more marked in the upper lobes. There are small patchy areas of interspersed lung parenchyma seen as well
There is mild bilateral pleural effusion seen, more on right side.
No significant mediastinal or hilar adenopathy is seen
Mediastinal fat planes appear clean
Minimal pericardial effusion is seen
There is minimal retrosternal collection seen with sternal sutures in situ.
Need suggestions on:
1. Is the respiratory problem not curable ? Despite broad range antibiotics, this problem is still at large. His blood gases test when he goes off the
ventilator show increasing levels of CO2 and dropping levels of O2. And there is fluid accumulation in his lungs. Another symptom is of excessive secretions in his lungs.
The secretions are not drying for good despite antibiotics).
Patient keeps coming back to ventilator because of these reasons.
2. Heart surgeon repeatedly claims that the new heart and valve are functioning ok. EF is 60 , which is good. Heart echo did not find any issues.
But Pulmonologist clarified that the respiratory problems started
only after surgery and that a comparison of tests conducted before and after the surgery prove this. Other sources mentioned that the change in physiology due to heart surgery resulted
in back pressure on lungs and that is why lungs have fluid accumulation. Anyone has suggestions on the root cause of this problem. And how this could be fixed.
