Visually assisted respiratory rehabilitation of a patient with sequelae of intraventricular hemorrhage: a clinical case

BACKGROUND: Rehabilitation of patients who have suffered from intraventricular hemorrhage is often complicated by respiratory dysfunction due to prolonged immobilization, intensive care consequences syndrome, and disturbances in physiological, anatomical, and topographic relationships. CLINICAL CASE DESCRIPTION: The patient, a 20-year-old man, suffered from cryptogenic non-traumatic intracranial hemorrhage. He was hospitalized with functional disorders in the form of central tetraparesis and bulbar syndrome. He suffered from nosocomial lower lobe pneumonia during his stay in the specialized department. According to visualization data, lower lobe pneumonia is in the resolution stage, lower lobe fibro atelectasis. Upon admission to the rehabilitation center, severe respiratory dysfunction was diagnosed. Visualization by the electrical impedance tomography of the lungs suggested the presence of hypoventilation zones in the dorsal parts of the right lung, uneven, acyclic ventilation, uneven ventilation in all regions of the lungs during spontaneous breathing, hyper perfusion of the dorsal part of the left lung, tachypnea; instrumental and laboratory diagnostic data revealed serous-purulent sputum and hypercapnia. Rehabilitated with positive dynamics. By the end of the course, uniform bilateral ventilation and normalization of clinical indicators were recorded. Pulmonary rehabilitation program: physical training, verticalization, positioning, extrapulmonary and intrapulmonary percussion, inhalation therapy, hardware physiotherapy, respiratory support with positive pressure at the end of exhalation. CONCLUSION: The examination revealed the presence of pronounced functional respiratory disorders that directly affect the plan and possibility of rehabilitation measures. Visualization allowed to clearly demonstrate the state of the impaired function and its dynamics during therapy. The result of successful restoration of the impaired function was obtained not only by visual representation using the electrical impedance tomography method, but also according to laboratory, instrumental diagnostics, and clinical examination. A multidisciplinary approach to managing a patient with pronounced impaired functions due to concomitant pathology is important. It is proposed for discussion to visualize using the electrical impedance tomography method in managing a patient with intensive care consequences syndrome with respiratory complications, as well as patients of a specialized pulmonology hospital.