Intrapulmonary Percussion Ventilation in a Patient with an Extremely Severe Course of a New Coronavirus Infection: a Clinical Observation

Justification: Acute respiratory distress syndrome (ARDS), which develops with a new coronavirus infection of severe acute respiratory syndrome 2 (SARS-CoV-2) of the coronavirus strain that causes coronavirus disease 2019 (COVID-19), is its severe complication that requires a comprehensive approach to diagnosis and therapy. In the severe form of COVID-19, viral pneumonia occurs in combination with ARDS, based on two pathological processes leading to fibrosis and loss of gas exchange function of lung tissue [1]. The problem of forced iatrogenism as a result of intensive therapy of this condition, which is a high risk of developing barotrauma, requires the search for new, effective and safe methods of treating such patients in a hospital setting. Description of the clinical case: A description of a clinical case of an extremely severe course of a new coronavirus infection SARS-CoV-2 with the development of ARDS in a 62-year-old man is presented. The complexity of the clinical situation consisted in the iatrogenic lung injury that was already present at the time of admission to the FSBI “A.I. Burnazyan SSC FMBC” of the FMBA of Russia, as a result of previously conducted respiratory therapy. The patient developed bullous transformation of both lungs, bilateral hydropneumothorax and pneumomediastinum, against the background of ARDS. The disease proceeded with the development of sepsis, septic shock, multiple organ failure. Upon admission to the intensive care unit of the Burnazyan Federal Medical Center, it was decided to use a combination of traditional ventilation, intrapulmonary percussion ventilation (IPVL) and veno-venous extracorporeal membrane oxygenation (V-V ECMO), which as a result led to the clinical recovery of the patient with further rehabilitation. At the moment, the patient has no manifestations of respiratory dysfunction, is socialized, leads an active lifestyle. Conclusion: Combination therapy, including the use of traditional ventilation with protective parameters, In-In ECMO and IPVL, has a positive effect on the restoration of lung tissue, preventing its persistent fibrosis, and allows increasing the effectiveness of further rehabilitation in patients with severe and extremely severe SARS-CoV-2 infection, which may be the basis for the use of this method in a wider number of patients.