PMC:7295558 / 8575-10356 JSONTXT

{"target":"http://pubannotation.org/docs/sourcedb/PMC/sourceid/7295558","sourcedb":"PMC","sourceid":"7295558","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7295558","text":"A 66-year-old man presented with a 5-day history of shortness of breath, fever and dry cough. His previous medical history was unremarkable. He reported having a family member that had traveled to the United States during the previous month. He presented to the ER with respiratory insufficiency syndrome. During his first day in the ICU, he was classified as a moderate ARDS with a PaO2/FiO2 ratio of 180 (Table 1). He was initially managed with HFNC and, due to an altered mental state, was then intubated using video laryngoscopy. On his third day, he developed an AKI with anuria and septic shock that was treated with vasopressors. On his fourth day, prolonged intermittent renal replacement therapy was started using a non-tunneled dialysis catheter. A TTE was done on his eighth day, showing an LVEF of 65% (Table 2), a mobile vegetation with a size of 12 × 10 mm that was attached to the septal leaflet of the tricuspid valve, and severe tricuspid regurgitation (Fig. 1a). Four consecutive blood cultures were performed and all were negative. No other of Duke’s criteria for infectious endocarditis were present. On his 14th day in the ICU, fever was again identified, accompanied by a new infiltrate on his chest X-ray. A diagnosis of ventilator-associated pneumonia was established and broad-spectrum antibiotics were started. At this time, a new RT-PCR for SARS-CoV-2 was performed, which was still positive. During his 22nd day in the ICU, the patient was still intubated, dependent of renal replacement therapy (RRT) and vasopressor support, with altered mentation (unarousable) during his unsuccessful ventilation weaning trials. 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