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American Journal of  Medical 
Science and Innovation (AJMSI) 

Overcoming the Challenges of  Prolonged Ventilation and Critical Illness Polyneuropathy 
in Severe ARDS Patients Due to Extensive Viral Pneumonia: A Case Report

Mohamed Elsamman Ahmed1*

Volume 2 Issue 2, Year 2023
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v2i2.2141
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: October 10, 2023
Accepted: November 05, 2023
Published: November 14, 2023

ARDS is a life-threatening condition requiring intensive care unit monitoring. We present a 
46-year-old male patient with ARDS and its complications, ventilator-associated pneumonia 
(VAP) and critcal illness polyneuropathy after extensive bilateral viral pneumonia.  The 
objective of  this case report is to understand better and manage the complications of  
ARDS. This study addresses ARDS and its complications, providing a comprehensive 
clinical understanding. It details a 46-year-old male patient’s case, treatment strategies, 
complications, weaning processes, and rehabilitation and emphasises the importance 
of  physical therapy. This case report discusses the successful management and weaning 
of  a patient with extensive viral pneumonia complicated with acute respiratory distress 
syndrome (ARDS), impending organ dysfunction, and critical illness polyneuropathy. The 
patient had a medical history of  diabetes, hypertension, and dyslipidemia. Initial treatment 
involved oxygen therapy, nebulization, and empirical antiviral for seasonal flu. However, 
the patient required invasive ventilation with sedation and muscle relaxants following the 
ARDSNET protocol due to worsening respiratory status and extensive lung infiltrates. 
Secondary bacterial infections were also identified and treated accordingly. The weaning 
process was initiated but was complicated by re-intubation and the development of  critical 
illness polyneuropathy. After successful weaning and recovery from ARDS and associated 
lung infections, physical therapy was provided for polyneuropathy regularly to overcome the 
manifest weakness all over the body muscles, including respiratory muscle weakness. The 
case report highlights the successful management of  a patient with viral pneumonia, ARDS, 
and critical illness polyneuropathy, highlighting the importance of  comprehensive treatment 
and physical therapy.

Keywords
Acute Respiratory Distress 
Syndrome (ARDS), Ventilator-
Associated Pneumonia (VAP), 
Oxygen Therapy, Critical Illness 
Polyneuropathy (CIP), Muscle 
Relaxant, Nebulization

1 Burjeel Farha Hospital Al Ain, Abu Dhabi, United Arab Emirates
* Corresponding author’s e-mail: MohamedElsamman12@outlook.com

INTRODUCTION
Viral pneumonia is a significant global health issue that 
can lead to serious complications such as ARDS and 
organ dysfunction, which usually necessitates invasive 
mechanical ventilation. Prolonged mechanical ventilation 
can also result in critical illness polyneuropathy, which 
causes muscle weakness and wasting along with the 
corticosteroids usually prescribed in such cases. This 
case report highlights a patient’s successful management 
and weaning with these complex complications. The 
definition of  ARDS was given in 2011 by The European 
Society of  Intensive Care Medicine, supported by The 
American Thoracic Society and the Society of  Critical 
Care Medicine, and it is known as the Berlin Definition. 
According to it, ARDS is characterised by the time frame 
of  one week from worsening of  the chronic condition, 
radiographic changes, lung oedema without left heart 
failure, and a PaO2 / FIO2 ratio of  5 cm2 H20 with 
continuous positive airway pressure (CPAP), with the 
presence of  bilateral shadows and lung oedema (Huppert 
et al., 2019). By definition, three ARDS categories have 
been identified. Subtypes are based on the degree of  
hypoxemia: mild (PaO2 / FIO2 < 300 mm Hg), moderate 
(PaO2 / FIO2 < 200 mm Hg), and severe (PaO2 / 
FIO2 <100 mm Hg) (Ferguson et al., 2012; Milacic et al., 
2018). ARDS implies diffuse alveolar damage (DAD) and 
injury to the lung’s capillary endothelium (Barbeta et al., 

2023). Injuries of  the capillary endothelium and alveolar 
epithelium lead to impaired fluid transport through 
alveoli and fluid accumulation rich in proteins within 
the alveoli, eventually leading to diffuse alveolar injury, 
with the release of  proinflammatory cytokines, such as 
Tumor Necrosis Factor (TNF), IL-1 and IL-6 (Rittayamai 
& Brochard, 2015). Neutrophils are activated, releasing 
toxic mediators, proteases and free radicals (Milacic et al., 
2018). Abnormalities of  transcription factors, including 
NF-cap B, needed for gene transcription for many pro-
inflammatory mediators, are present in ARDS (Forel et 
al., 2012). Endothelin-1, angiotensin-2 and phospholipase 
A-2 also significantly increase vascular permeability 
(Montealegre-Gómez et al., 2021).
ARDS impairs epithelial integrity, leading to alveolar 
leakage, altered fluid and ion balance, and alveolar 
oedema (Lucas et al., 2022). Damage to type II epithelial 
cells reduces surfactant generation, causing known 
surfactant deficits(Agudelo et al., 2020). Breaching the 
epithelial barrier can increase the risk of  septic shock 
in individuals with bacterial pneumonia (Eisenhut & 
Shin, 2020). Excessive alveolar epithelial injury results in 
fibrosis, as the inability to regenerate leads to the etiology 
of  fibrosis. Therefore, maintaining a physiological balance 
is crucial for preventing ARDS(Michalski et al., 2022). 
The fibrosis process is stimulated by interleukin (IL) -1. 
Progression to fibrosis can be predicted by the increased 



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values of  procollagen peptide III (PCP-III) in the 
sample obtained by BAL. The diseases most commonly 
associated with ARDS can be both lung and systemic 
(Table 1). Mycobacteria pneumoniae, although associated 
with unilateral pneumonia, can also lead to changes that 
correspond to acute respiratory distress syndrome (6, 7).
The main symptoms include breathing difficulties 
(dyspnoea), rapid breathing (tachypnoea), extremely 
deep breathing (hyperventilation) and reduced oxygen 
levels in the circulation (hypoxemia) (Kallet et al., 
2022). Typically, ARDS manifests within a timeframe 
of  24 to 48 hours following the onset of  an underlying 
disease or the worsening of  an existing condition 
(Henderson et al., 2017). A distinctive hallmark of  
ARDS is the resistance of  hypoxemia to conventional 
oxygen therapy, necessitating the implementation 
of  mechanical ventilation (Henderson et al., 2017). 
Importantly, one of  the notable complications associated 
with mechanical ventilation is the heightened risk of  
bacterial pneumonia, often triggered by gram-negative 
bacteria such as Pseudomonas aeruginosa, Acinetobacter 
baumannii, and Stenotrophomonas maltophilia, which 
collectively account for 40% of  cases. Enterobacteriaceae 
contribute to 29% of  cases, while methicillin-resistant 
Staphylococcus aureus (MRSA) is implicated in 21% of  
instances (Trouillet et al., 1998). White blood cell counts 
are frequently elevated in laboratory tests, which may 
indicate the presence of  sepsis or pneumonia.
In contrast, an assessment of  the acid-base balance may 
show a drop in pH, with values below 7.4 indicating 
respiratory acidosis and hypoxia (Berend & Duits, 2019).  
Pulmonary oedema is frequently detected in ARDS as 
well by radiographic examinations like chest X-rays (CXR) 
(Gosangi et al., 2022). However, Computed tomography 
(CT) scans may be necessary in some circumstances for 
a more thorough analysis. An ultrasound of  the heart is 
performed (echocardiography) to rule out any cardiac-
related problems. Pulmonary hypertension can be 
ruled out with the help of  arterial pulmonary catheter 
monitoring. Bronchoscopy may also be taken into 
account when it is clinically necessary for the assessment 
of  lung conditions (Nowroozpoor et al., 2019).
The management of  ARDS includes dealing with 
underlying causes, enhancing oxygenation, offering 
supportive care, and avoiding complications. The 

management of  fluid balance, positioning of  patients, 
administration of  medications, provision of  nutrition, 
provision of  supportive care, monitoring of  hemodynamic 
parameters, management of  pain control, prevention of  
complications, treatment of  underlying conditions and 
consideration of  Extracorporeal Membrane Oxygenation 
(ECMO) in severe cases are important components 
(Banavasi et al., 2021; Peck & Hibbert, 2019).    
This study aims to fill a research gap in the field of  ARDS 
and its complications. It provides a comprehensive 
clinical understanding of  ARDS, its complications, and 
the challenges of  managing these conditions in patients. 
The case report presents a detailed case of  a 46-year-old 
male patient with ARDS, discussing treatment strategies, 
identifying and managing complications, weaning 
processes, rehabilitation, patient profile, and overall 
management. The study also highlights the importance 
of  physical therapy and rehabilitation in addressing 
complications and regaining muscle strength.

Case Presentation
A 49-year-old male was admitted to Burjeel Farha 
Hospital due to several symptoms, including shortness 
of  breath, dry cough, weakness, fatigue and an elevated 
body temperature. The symptoms had been worsening 
over two days, after which he was admitted to the general 
ward. The patient’s medical history was taken primarily. 
The patient had a medical history of  diabetes mellitus 
type 2, which was being managed with metformin intake, 
as well as hypertension and dyslipidemia, for which the 
patient was on medication. During treatment, a screening 
test for influenza A and B was performed in addition to 
various other routine lab tests, including CRP, abnormal 
liver function parameters and inflammatory markers. 
Chest X-ray was performed as well, and bilateral infiltrates 
and haziness were noticed. 
On the first day of  admission to the ward, the patient 
was conscious and mobile but presented with significant 
respiratory distress (Dyspnoea), tachycardia and a high fever 
(temperature >38.5 °C). The physical examination revealed 
auscultatory fine crackles at the basal parts of  the lung.

Laboratory and Radiological Findings
In the obtained laboratory tests, the increase in 
inflammatory parameters with elevated values of  D 

Table 1: Pulmonary and Systemic Diseases Associated with ARDS
S. No Pulmonary diseases or conditions Systemic Diseases
1 Pneumonia                                      Sepsis                
2 Aspiration of  Gastric Contents        Difficult Trauma         
3 Lung Contusion                               Multiple Fractures       
4 Inhalation Lung Injury                      Head Injuries             
5 Drowning       Burns  
6 Overdose of  Narcotics                    Multiple Transfusion        
7 Bypass      Pancreatitis
8 Post Cardiopulmonary      



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dimer and liver function parameters were verified (WBC 
>12.5, Hgb 12 gm, PLT 331, CRP 120, AST 142, ALT 
180, GGT 227, LDH 751, CK 68, K 3.8, Na 137, D dimer 
>1.5). The performed ABG showed a global respiratory 
insufficiency, metabolic compensated (p H 7.43, p CO2 
48, p O2 5.1, HCO3 28.4, BE 5.3, with SO2 84%).
In the chest x-ray (CXR) conducted at the urgent care 

(UC), the report noted bilateral shading in the lower and 
middle lung fields, as illustrated in Fig 1. Additionally, 
the lung computed tomography (CT) scan described 
consolidation of  the lung tissue, originating from the 
lung’s apex and extending through the middle and dorsal 
basal segments, accompanied by typical indications of  
pulmonary oedema, as depicted in Fig 2.

Table 2: Values of  inflammatory parameters before treatment
Parameter Value Normal Range
White Blood Cell Count >12.5 4.5 - 11 x 10^9/L
Hemoglobin (Hgb) 12 gm 13.8 - 17.2 g/dL
Platelet Count (PLT) 331 150 - 450 x 10^9/L
C-reactive protein (CRP) 120 < 10 mg/L
Aspartate Aminotransferase (AST) 142 8 - 48 U/L
Alanine Aminotransferase (ALT) 180 7 - 55 U/L
Gamma-glutamyl transferase (GGT) 227 9 - 48 U/L
Lactate Dehydrogenase (LDH) 751 140 - 280 U/L
Creatine Kinase (CK) 68 55 - 170 U/L
Potassium (K) 3.8 3.5 - 5.0 mmol/L
Sodium (Na) 137 135 - 145 mmol/L
D-dimer >1.5 The reference range may vary
Arterial Blood Gas (ABG)
- pH 7.43 7.35 - 7.45
- pCO2 48 35 - 45 mm Hg
- pO2 5.1 75 - 100 mm Hg
- HCO3 28.4 22 - 28 mmol/L
- Base Excess (BE) 5.3 -2 to +2 mmol/L
- Oxygen Saturation (SaO2) 84% 95 - 100%
- Lactates 2.2 0.5 - 2.2 mmol/L

Figure 1: CXR showing patchy areas of  consolidation 
noted in both lung fields in the mid and lower zones 
predominantly

Figure 2: CT chest showing extensive areas of  peripherally 
distributed foci of  consolidation and ground glass opacities 
in both lungs.

Treatment Administration
Hospital treatment was initiated in the form of  
oxygen therapy, nebulisation, empirical antibiotics and 
antipyretics. Soon after the admission to the ward, the 
patient’s condition worsened. Central cyanosis occurred, 
and repeated ABG showed: p H 7.51, p CO2 5.3, p O2 3.8, 

HCO3 30.4, BE 8.2, SaO2 63.5, lactates 2.2. Due to the 
need for monitoring of  vital functions and the possibility 
of  mechanical ventilation, the patient was transferred to 
the Intensive Care Unit.
Non-invasive ventilation (NIV) was initially used for the 
first two days after the patient was admitted to the intensive 



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care unit (ICU). The patient’s oxygen saturation remained 
appropriate during this time, and the breathing effort was 
controllable. However, the patient’s health appeared to 
deteriorate about 36 hours into the NIV treatment. The 
hypoxic index showed low blood oxygen levels, while SAO2 
pulse oximetry measurements fell below 85%. Recognising 
the patient’s intolerance to NIV and taking into account 
the diagnostic criteria for ARDS, which were based on the 
patient’s low hypoxia index and the presence of  bilateral 
lung infiltrates, the decision was made to begin invasive 
mechanical ventilation. This procedure followed the 
ARDSNET protocol and included the administration of  
sedatives and muscle relaxants. The ARDSNET protocol 
builds a strong emphasis on using protective lung methods 
and modifying positive end-expiratory pressure (PEEP) 
levels according to the oxygenation level of  the patient. 
This strategy aims to enhance ARDS patient outcomes and 
ventilator management efficiency.
The patient was intubated on the third day of  their stay 
in the ICU, linked to mechanical ventilation in assist-
control (A/C) mode, and their tidal volume (Vt) and a 
fraction of  inspired oxygen (FiO2) were set to 20 millilitres 
per kilogram (f20) and 0.7, respectively. The ICU staff  
attentively observed the patient’s breathing pattern 
throughout the day. According to the patient’s evolving 
state, the mechanical ventilation mode was changed 
several times, switching between the Assist-Control (A/C), 
BiLevel, and spontaneous modes as judged required.
To treat the patient’s condition, a number of  medications 
were started, including corticosteroids, bronchodilators, 
oseltamivir (an antiviral drug), a combination of  intravenous 
antibiotics to treat potential infections, and prophylactic 
anticoagulants to prevent blood clots. The diagnosis was 
made as viral pneumonia brought on by an unidentified 
virus despite the fact that initial blood and sputum cultures 
did not indicate bacterial growth, and two COVID-19 
reverse transcription polymerase chain reaction (RT-
PCR) tests yielded negative results. This conclusion was 

reached because influenza A and B screening tests likewise 
produced negative findings.
Laboratory results revealed significantly raised levels of  
lipase, amylase, and liver enzymes, indicating potential 
impeding organ dysfunction. Inflammatory markers 
were also discovered to be increased, indicating a lively 
inflammatory response. The patient was completely 
sedated while on AC mode mechanical ventilation 
between the third and seventh days in the ICU, with help 
from the muscle relaxants cisatracurium and midazolam. 
Every 24 hours, a sedation vacation strategy was adopted, 
allowing patients brief  intervals of  reduced sedation. 
On day ten, on the tenth day, the patient developed a 
fever and coloured sputum during suction, indicating 
secondary bacterial infections after over a week of  invasive 
ventilation. The condition was diagnosed as ventilator-
associated pneumonia (VAP), requiring an increase in 
antibiotic therapy. The patient’s weaning process began 
with a sedation vacation and reduced ventilatory support, 
transitioning to spontaneous pressure support ventilation.
Further evaluations showed that the patient had general 
weakness, which was characterised by wasting muscles, 
areflexia (lack of  reflexes), and deteriorating muscle 
strength.
These results suggested critical illness polyneuropathy. 
This diagnosis was confirmed after a neurology referral 
using nerve conduction and electromyography studies. 
The results of  the NCS are provided in Tables 4, 5 and 6, 
and the graphical representation can be seen in Figures 3, 
4 and 5.
A Sensory Nerve Conduction Study (NCS) has revealed 
that the median nerve on the right wrist has a latency of  
35.3 ms, while the ulnar nerve has a latency of  36.2 ms. 
The peroneal nerve on the left ankle has a latency of  ***, 
while the tibial nerve on the left side of  the ankle has a 
latency of  65.4 ms. These latency measurements are crucial 
for diagnosing and evaluating sensory nerve function, 
providing information about the speed at which sensory 

Table 3: Repeated ABG results
Parameter Value Normal Range
- pH 7.51 7.35 - 7.45
- pCO2 5.3 35 - 45 mm Hg
- pO2 3.8 75 - 100 mm Hg
- HCO3 30.4 22 - 28 mmol/L
- Base Excess (BE) 8.2 -2 to +2 mmol/L
- Oxygen Saturation (SaO2) 63.5 95 - 100%
- Lactates 2.2 0.5 - 2.2 mmol/L

Table 4: Nerve Conduction Study (NCS) Data
Nerve and Location Latency 1 (ms) Latency 

2 (ms)
Amplitude Segment 

Distance (mm)
Interval 
(ms)

NCV 
(m/s)

Median Right Wrist 3.5 4.0 25.7 uV Wrist 150 43.1
Ulnar Left Wrist Not specified 2.7 9.6 uV Wrist 130 48.5
Ulnar Right Wrist Not specified 2.7 48.9 uV Wrist 130 48.9



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Figure 3: Motor nerve conduction Study graphical representation

Table 5: Sensory nerve conduction study results
Site Lat. 1 

(ms)
Lat. 2 
(ms)

Amplitude Segment 
Dist (mm)

Interval 
(ms)

NCV 
(m/s)

Median Right Wrist 3.5 4.0 25.7uV Wrist 150 43.1
Ulnar Left Wrist 2.7 9.6uV Wrist 130 48.5
Ulnar Right Wrist 2.7 48.9uV Wrist 130 48.9
Sural Left
Sural Right
Superficial Peroneal Left (Mid. branch)
Superficial Peroneal Right (Mid. branch)



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Figure 4: Sensory nerve conduction graphical representation

Table 6: Sensory Nerve Conduction Study Latency Measurements
Nerve Side Site F-Lat F-M Lat
Median Right Wrist 35.3ms 35.3ms
Ulnar Right Wrist 36.2ms 36.2ms
Peroneal Left Ankle *** ***
Peroneal Right Ankle **** ***
Tibial Left Ankle 65.4ms 65.4ms
Tibial Right Ankle 64.7ms 64.7ms



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Figure 5: F-Wave representation

Figure 6: CXR showing bilateral airspace opacities noted, 
more on right side. Compared to previous image, some 
improvement noted.

Figure 7: CT chest showing areas of  consolidation 
bilaterally mainly rt lung lobes.

signals are conducted along these nerves.
After a failed weaning trial, the patient successfully 
weaned from mechanical ventilation after 22 days. 
Laboratory markers improved after recovery from ARDS 
and lung infections. Physical therapy continued to address 
polyneuropathy, guided by neurological assessments and 

nerve conduction and electromyography studies.

RESULTS AND DISCUSSIONS
The case report describes the successful management 
and weaning of  a ventilated patient with severe ARDS, 
viral pneumonia, VAP, and critical illness polyneuropathy. 



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Despite a robust inflammatory response, the patient’s 
oxygenation status improved over time, indicating 
better lung function and oxygenation. The patient’s 
organ dysfunction parameters fluctuated throughout 
the treatment period, suggesting potential multi-organ 
involvement. The case highlights the importance of  
respiratory compensation and managing complex cases.
The patient was successfully weaned from mechanical 
ventilation due to improved lung function and 
oxygenation, effective complication management, and 
early physiotherapy, as seen in Figs 6 and 7. The case 
highlights the importance of  ongoing rehabilitation and 
physiotherapy in critically ill patients, as polyneuropathy 
is a common complication, and ongoing rehabilitation is 
necessary to restore muscle strength and function.
This case report highlights the complexity of  managing 
severe viral pneumonia caused by ARDS. The patient’s 
success was achieved through evidence-based protocols, 
close monitoring of  inflammatory markers, and organ 
dysfunction parameters. The patient had a combined 
infection with Corynebacterium amycolatum spp heavy 
growth and enterococcus spp, resulting in increased 
inflammatory parameters. The patient was treated with 
antibiotic linezolid plus gentamicin due to the bacterium’s 
resistance to standard antibiograms. After completing 
antibiotics, the patient was transferred to the ward for 
further monitoring. Oral antibiotic therapy continued 
for a week, along with physical therapy sessions and 
supportive therapy. The patient was discharged in good 
condition and hemodynamically stable for further 
ambulatory monitoring.
Patients with ARDS frequently need treatment in intensive 
care units. There is no particular treatment. The main 
focus of  the treatment is support. A significant part is 
played by mechanical ventilation and the proper usage of  
oxygen (Bos et al., 2018). Knowing that lung transduction 
with positive pressure can aggravate the current illness is 
a crucial development in therapy(Bos et al., 2018). This 
mindset has helped to design a new approach to treating 
mechanical ventilation that combines positive end-
expiratory pressure (PEEP) and small breathing volumes 
(6ml/kg) (Candan et al., 2020). This case report details the 
medical history, diagnosis, treatment, and management 
of  a 49-year-old male patient with diabetes mellitus type 
2, hypertension, and dyslipidemia. The patient presented 
with respiratory distress, tachycardia, and high fever. 
However, his condition worsened rapidly, leading to 
central cyanosis and worsening respiratory parameters. 
The patient was diagnosed with viral pneumonia due 
to an unknown virus, and after over a week of  invasive 
ventilation, he developed VAP. The patient underwent 
a weaning process from mechanical ventilation, with 
periods of  sedation and a gradual reduction in ventilatory 
support. Physical therapy was initiated to address critical 
illness polyneuropathy. After 22 days of  mechanical 
ventilation and successful management of  complications, 
the patient was successfully weaned from the ventilator. 
The case highlights the importance of  ongoing 

rehabilitation and physiotherapy in critically ill patients, as 
polyneuropathy is a common complication, and ongoing 
rehabilitation is necessary to restore muscle strength and 
function. The case report emphasises the complexity of  
managing severe viral pneumonia complicated by ARDS, 
emphasising the importance of  evidence-based protocols, 
close monitoring of  inflammatory markers, and the role 
of  physiotherapy in achieving a successful outcome. 
Appropriate oxygen therapy in other medical conditions 
can also prevent the secondary development of  ARDS. 
Determan and associates performed a controlled 
randomised study with 150 patients that compared the 
use of  small breathing volumes versus standard patients 
with critical illness and pointed to reduced production 
of  inflammatory cytokines in patients treated with 
low air volume (Determann et al., 2010). Then, there 
are also adequate nutrition and hydration. Antibiotic 
therapy is mandatory if  accompanied by secondary 
bacterial infections or ventilator-associated pneumonia 
(Papazian et al., 2020). Corticosteroids are occasionally 
administered to resolve the primary condition; otherwise, 
their use is controversial. Correction of  acid-base status 
and other therapies (diuretics, analgesics, anxiolytics, 
antihypertensives) is regulated as needed. Suppose 
the recovery does not occur in the first seven days. In 
that case, there is a greater likelihood that progressive 
lung injury will develop, followed by inflammation 
of  the interstitium and later fibrosis. Applying early 
interventions, maintaining adherence to evidence-based 
protocols, and closely observing inflammatory markers 
and organ dysfunction parameters prove vital for 
achieving a positive outcome (Papazian et al., 2020). 
According to the International Nosocomial Infection 
Control Consortium (INICC), the frequency of  VAP is 
13.6 versus days spent on ventilation support. However, 
the incidence varies depending on the hospital groups 
and hospital conditions, so the frequency of  VAP ranges 
between 13-51 and 1000 days spent on ventilation 
(Rosenthal, 2016). Patients who survive the ARDS 
episode usually have lasting effects that are reflected in 
reduced HRQOL (health-related quality of  life) (Morgan, 
2021). To enhance our overall comprehension of  ideal 
treatment strategies as well as long-term outcomes in 
similar cases, further research endeavours are necessary. 
Ventilator-associated pneumonia (VAP) is a costly and 
prevalent infection in ICUs, causing significant morbidity 
and mortality. A study examined 36 cases over a year, and 
findings showed bacterial growth, with Staphylococcus 
aureus being the most common pathogen. Half  of  the 
isolated bacteria showed multi-drug resistance. Treatment 
options for VAP include Imipenem, amikacin, linezolid, 
vancomycin, and levofloxacin. The study highlights 
the need for up-to-date knowledge of  bacterial causes 
and antibiotic susceptibility patterns when developing 
empirical treatment regimens (Abd-Elmonsef  et al., 
2018). Extracorporeal Membrane Oxygenation (ECMO) 
can be a life-saving intervention when conventional 
treatments fail. A 50-year-old female with severe ARDS 



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developed ECMO therapy after 14 days, resolving her 
symptoms and successfully weaning from the ventilator. 
ECMO provides lung support, preserves hemodynamic 
stability, and is crucial for managing severe ARDS due to 
swine flu when combined with protective lung ventilation 
and timely weaning (Taneja et al., 2018). Another study 
presents two Chinese patients with pre-existing non-
immune diseases who contracted severe H7N9 pneumonia 
and neurological complications. Both exhibited muscle 
weakness in their limbs, prolonging ventilator-weaning 
periods. Despite the clinical diagnosis, distinguishing 
between intensive care unit-acquired weakness and 
Guillain-Barré syndrome (GBS) was challenging due to 
a lack of  lumbar punctures and muscle/nerve biopsies. 
Gradual improvement in neurological conditions was 
observed after extensive treatment (Jin & Tang, 2018).
Studies emphasise the importance of  staying updated 
on bacterial profiles and antibiotic resistance patterns 
for effective VAP management. They also highlight the 
potential of  ECMO as a life-saving intervention in severe 
respiratory distress cases. The case report demonstrates 
the successful management of  a complex case involving 
polyneuropathy and VAP-related ARDS, underlining the 
need for a comprehensive approach, including infection 
control measures, reduction in mechanical ventilation and 
timely physical therapy.

CONCLUSION
The excellent management of  a 46-year-old male 
patient with viral pneumonia, ARDS, and critical illness 
polyneuropathy is discussed in this case report. It 
emphasises the value of  comprehensive care that includes 
nebulisation, oxygen therapy, and antiviral therapy. It also 
emphasises the importance of  promptly recognising and 
treating problems, like following bacterial infections. 
The report also emphasises the vital role that physical 
therapy plays in recovery, particularly when treating 
polyneuropathy associated with critical disease.

Acknowledgement
The author is grateful to the clinical and administrative 
teams at Burjeel Farha Hospital for their cooperation in 
managing this case.

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