Cureus . Humidifier Use and Prone Positioning in a Patient With Severe COVID-19 Pneumonia and Endotracheal Tube Impaction Due to Highly Viscous Sputum

[tetano]

Cureus


. 2020 Jun 15;12(6):e8626.
doi: 10.7759/cureus.8626.
Humidifier Use and Prone Positioning in a Patient With Severe COVID-19 Pneumonia and Endotracheal Tube Impaction Due to Highly Viscous Sputum


Ryu Sugimoto ¹ , Tsuneaki Kenzaka ^{2 1} , Moemi Fujikawa ¹ , Satoru Kawasaki ¹ , Hogara Nishisaki ¹



Affiliations

• PMID: 32550095
• PMCID: PMC7296879
• DOI: 10.7759/cureus.8626

Abstract

COVID-19 can lead to severe pneumonia, requiring mechanical ventilation. While increased sputum secretion could cause airway obstruction during mechanical ventilation, there are few reported cases in the literature. We report a case of a 65-year-old man with diabetes and severe COVID-19 pneumonia requiring mechanical ventilation and treated with hydroxychloroquine, azithromycin, nafamostat, and prone positioning. Initially, mechanical ventilation consisted of a heat moisture exchanger, endotracheal tube aspiration, and subglottic secretion drainage using a closed suction system. However, endotracheal tube impaction by highly viscous sputum occurred during this mechanical ventilation system. Replacing the endotracheal tube, the use of a humidifier instead of a heat moisture exchanger, and prone positioning contributed to the patient being weaned off mechanical ventilation. Although anti-aerosol measures are important for severe COVID-19 pneumonia, attention should be given to potential endotracheal tube impaction during mechanical ventilation.

Keywords: coronavirus 2019 (covid-19); coronavirus disease 2019; covid-19 respiratory failure high altitude pulmonary edema high flow nasal cannula acute respiratory distress syndrome; invasive mechanical ventilation; key words corona; sars cov-2; sars-cov-2 (severe acute respiratory syndrome coronavirus -2); tube impaction.