I have tuberculosis (TB) disease, type1 respiratory failure. Oxygen was given, oxygenation improves but falls to LVL on presentation. What support should be given before the onset of hypercapnia? I have dry cough for two weeks, blood in sputum, fever, sweating and weight loss.
Welcome to icliniq.com. As you said, the patient has tuberculosis (TB), hypoxia is more common which leads to type 1 respiratory failure. So only supplemental oxygen is not enough. We should start noninvasive ventilation as early as possible before hypercarbia sets in. So the possible options for non-invasive ventilation (NIV) are continuous positive airway pressure (CPAP) or (bilevel positive airway pressure) BIPAP depending on availability. The inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP) pressures can be set up according to blood oxygen levels and oxygen saturation to be aimed to keep above 95 %. Minimal sedation will keep the patient calm and also help to reduce further hemoptysis. Supportive measures like good nutrition and good nursing care should help to recover faster. Frequently keep a watch on blood gases. If NIV is not helping to keep oxygen above 95 % or hypercarbia sets in, mechanical ventilation may be needed. Ultimately we have to titrate depending on the blood oxygen levels. Antitubercular treatment must be continued simultaneously. Antibiotics according to infection markers. The probable cause is TB. Investigation to be done is arterial blood gas. The differential diagnosis is pneumonia. The treatment plan include NIV and anti TB treatment.
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