Doctors turn around a critically ill elderly

Bhubaneswar: Doctors at SUM Ultimate Medicare here battled for 57 days to successfully turn around a 79-year-old man down with severe pneumonia.

Nikunja Kishore Das was admitted on September 23 with fever, shortness of breath and bilateral pneumonia. The patient was immediately admitted to the ICU and put on non-invasive ventilation. As he already had multiple co-morbidities including diabetes, hypertension, hypothyroid, chronic kidney disease (CKD), arterial fibrillation and had undergone angioplasty it made handling of the case tricky.

A multidisciplinary team of doctors comprising cardiologists, nephrologists, pulmonologist, plastic surgeon and intensivists treated the patient.

Administration of antibiotics and other medication gradually improved his condition and within two weeks he was shifted to a cabin, Dr. Anand Mishra, Senior Consultant, Critical Care, in the hospital, said.

However, after spending two days in the cabin, he started to show irregular heartbeat, urinary bleeding and had difficulty in breathing due to which he was shifted back to the ICU and was put on ventilator. He also required dialysis and blood multiple times due to renal failure and low hemoglobin.
Prone ventilation was also done several times due to severe pneumonia and Acute Respiratory Distress Syndrome (ARDS) and Tracheostomy was also done because of prolonged stay on ventilator, Dr. Mishra said.

In addition, the patient had a floating blood clot in the neck vein. Medication was given to control the heart rate irregularities.

Unanticipated complications during the course of treatment process made it more challenging, he said adding it was difficult to wean the patient from the ventilator due to his cardiac and renal co-morbid conditions, but it was gradually achieved over the next few days and the tracheostomy was closed.

The patient was shifted back to the cabin with one litre oxygen support. Regular physiotherapy and proper diet plan helped in early recovery post tracheostomy closure.

The patient was finally discharged from the hospital after 57 days. Round-the-clock vigil by ICU team and daily care plan by the multidisciplinary team helped while repeated counselling of family members with a positive attitude was the core element for successful outcome of the treatment, Dr. Mishra said.