With TB, what support do I need before hypercapnia onset?

Question

Hello doctor,

I have tuberculosis (TB), a type of respiratory infection. Oxygen was given, and oxygenation improved but fell to LVL on presentation.

What support should be given before the onset of hypercapnia?

I have had a dry cough for two weeks, blood in my sputum, fever, sweating, and weight loss.

Please advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

As you said, the patient has tuberculosis (TB), and 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 keep them above 95 percent.

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 percent 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. The investigation to be done is an arterial blood gas. The differential diagnosis is pneumonia. The treatment plan includes NIV and anti-TB treatment.

I hope you find this helpful.

Let me know if I can assist you further.

Thank you.