A 35-year-old female nonsmoking patient underwent total thyroidectomy on August 20, 2007 for follicular thyroid neoplasia and was discharged in good general condition after 48 h.
Established on August 25 due to general malaise, odynophagia, headache, fever, chills, cervical pain, cough and mucopurulent cough, being admitted to the general care unit.
On physical examination, the patient was in regular general condition, wet, oriented, FC: 90 lat/min, BP: 106/60 mmHg, FR: 24 resp/min, T: 37.8°C.
The diagnosis of surgical wound infection was raised and treatment with ceftriaxone 1 g/day IV was initiated.
The patient had fever and progressive respiratory distress requiring oxygen supply at 35% to correct gas exchange disorder (Pa02/Fi02: 259).
Blood count showed leukopenia (2,700/mm3) with left shift (13% bacilliform), CRP: 5.4 mg/dL dry matter, GSA: pH: 7.46 mEq/Pa02 upper lobe act: 54.4 mmHg, Sa02
The clinical condition of the patient rapidly deteriorated, with increased respiratory distress and impaired gas exchange (FR: 32 resp/min, Fi02: 50% to achieve Sa02>90%), blood pressure slow (FR:
APACHE on admission: 18.
Table 1 describes the evolution of laboratory tests.
Chest X-ray showed progression of bilateral pulmonary infiltrates within eight hours.
The patient was intubated and mechanically ventilated.
Cervical computed tomography ruled out suppurative collection in the operative area and chest computed tomography (CAT) showed diffuse opacities in the lung parenchyma, especially in the lower respiratory lobes with severe bilateral respiratory distress syndrome.
The patient was managed with volume infusion, noradrenaline continuous infusion (0.15 γ/kg/min), broad-spectrum antibiotics (tazone 4.5 g every 8 h, vancomycin 1 g every 12 h and levofloxacin 500).
The patient was treated conservatively with anti-erythrombin agents plus anti-hemodynamic instability for 72 h, requiring support with noradrenaline in continuous infusion, Pa02/FI02 around 200, and cefmicin sensitive on the third day
At 72 h, oxygen was removed hemodynamically and the vasoactive drugs were removed. At 28 h, PEEPb was removed. However, the patient required mechanical ventilation support, and respiratory support was discontinued.
The clinical evolution was favorable, he remained well adapted to MV with low oxygen requirements, stable hemodynamics and was discharged without incidents on August 31.
The patient had no new complications during the evolution and was discharged one week later, with indications for monitoring respiratory diseases and endocrinology.
