Bridging treatment in respiratory failure caused by Mycoplasma Pneumoniae infection

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Simona Tantillo https://orcid.org/0000-0001-6583-539X
Francesca Franzoi https://orcid.org/0009-0009-6285-2667
Manuel Losito https://orcid.org/0009-0005-1619-086X
Martina Guarnera https://orcid.org/0000-0001-8266-0595
Irene Ottaviani https://orcid.org/0000-0002-9150-1323
Nicola Cilloni https://orcid.org/0000-0001-9519-1986

Keywords

pneumonia, mycoplasma pneumoniae, critical ill patients

Abstract

Community-acquired pneumonia (CAP) is a common respiratory infectious disease, in 7.5% of cases the responsable pathogen is represented by Mycoplasma Pneumoniae, 4% of these patients require hospitalization in Intensive Care Unit (ICU). We describe two cases of two young male patients with acute respiratory failure caused by Mycoplasma pneumoniae. They were admitted to the ICU with a high risk of requiring intubation, but this was avoided through an individualized treatment. The first case underscores the potential efficacy of high-flow nasal oxygen, supported by esophageal pressure swing (ΔPes) monitoring, evaluating the patient's respiratory effort and titrating the oxygen therapy administered. In the second case, the patient's hypoxemia was treated with high-flow oxygen therapy with inhaled nitric oxide guided by a high shunt fraction. Through the analysis of these two cases, we emphasize the crucial importance of personalized management of hypoxemia in severe instances, as a bridge treatment while waiting for antibiotic therapy to be effective. Additionally, despite the patients not requiring intubation, it is imperative to admit and manage severe cases in ICU. This approach facilitates close monitoring and the potential for therapeutic escalation, ensuring comprehensive care for optimal patient outcomes. Further research is warranted to elucidate the optimal approach to non-invasive respiratory support and prevention of patient self-inflicted lung injury in the early stages of acute hypoxemic respiratory failure. Further researches are needed to assess the efficacy of inhaled nitric oxide in preventing tracheal intubation.

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