PG 2025: Pulmonary Literature Review and Interactive Complex Case Presentations (PG)-Restrepo_CAP_Case

Restrepo_CAP_Case_QA

Pdf Summary

This case discussion, led by Dr. Marcos I. Restrepo, a noted pulmonary and critical care specialist and director at the South Texas Veterans Health Care System, presents a 75-year-old male patient with multiple comorbidities including COPD, atrial fibrillation, coronary artery disease (status post quadruple bypass), peripheral vascular disease, type 2 diabetes, hyperlipidemia, and hypertension. The patient experienced acute onset shortness of breath and lethargy, worsening over two days and resulting in emergency medical services involvement. Upon emergency department arrival, he was tachycardic, tachypneic, severely hypoxic with oxygen saturation in the 40s, and increased work of breathing. Initial oxygen therapy and BIPAP failed to improve his status, necessitating emergent intubation. Chest X-ray revealed basilar airspace opacities suspicious for pneumonia. Lab results showed leukocytosis (17,000/ml) and hyperglycemia (glucose 291 mg/dL). The patient was started on broad-spectrum antibiotics vancomycin and cefepime and admitted to the ICU for mechanical ventilation.<br /><br />The discussion highlights key clinical management considerations through guided questions:<br />- Whether to change the antibiotic regimen,<br />- The appropriateness of ordering additional diagnostics such as chest CT or inflammatory markers like C-reactive protein,<br />- The use of systemic corticosteroids in this context,<br />- Decisions about continuation or cessation of antibiotics,<br />- And recommendations regarding pneumococcal vaccination during follow-up.<br /><br />Dr. Restrepo disclosed no conflicts of interest, no ties to the tobacco industry, and no discussion of unapproved medications. He serves on ATS/IDSA guideline panels relevant to pneumonia and hospital-acquired infections. The session underlines critical decision points in managing severe pneumonia in a high-risk elderly patient, integrating evidence-based guidelines and clinical judgement in intensive care settings.

Keywords

COPD

Chronic Obstructive Pulmonary Disease

atrial fibrillation

coronary artery disease

pneumonia

mechanical ventilation

broad-spectrum antibiotics

vancomycin

cefepime

systemic corticosteroids

pneumococcal vaccination