Management of Acute Respiratory Failure in Patient with Post-Tuberculosis Lung Disease (PLTD): A Case Report

Abstract

PTLD causes persistent structural lung damage and reduced respiratory reserve, increasing the risk of acute respiratory failure during pulmonary infection. No specific protocol exists for escalation of respiratory support or ventilator weaning in PTLD. A 27-year-old woman with previously treated pulmonary TB presented with progressive dyspnea, increasing WOB, and hypoxemia. Chest imaging showed fibrosis, consolidation, atelectasis, and right lung volume loss, while microbiological testing for TB was negative. HFNC increased oxygen saturation to 100%, but respiratory distress persisted and consciousness deteriorated, prompting intubation and invasive mechanical ventilation. The patient received ventilator support, empiric antibiotics, progressive nutritional and early mobilization support, and weaning using an extensive SBT strategy as tolerated. She was successfully extubated on day four and discharged after 13 days without supplemental oxygen, independent in daily activities, and gaining weight. Normal oxygen saturation during oxygen therapy does not necessarily indicate adequate ventilation/reduced respiratory load and may conceal a risk of P-SILI. Timely intubation, tolerance-based weaning, and early integration of nutritional and mobilization supported respiratory recovery and successful extubation. Therefore, management of acute respiratory failure in PTLD should rely on comprehensive assessment beyond oxygen saturation and an individualized multidisciplinary approach.