Managing Severe Tuberculosis: Treatment Strategies and Patient Care

After a critical stage of pulmonary tuberculosis, treatment directions and recommendations include the following: 1. Continuation of Antitubercular Therapy: Ensure adherence to a full course of antitubercular medications, typically including isoniazid, rifamp

Hello Doctor,
My mother is currently 66 years old and recently experienced sudden hemoptysis, which led to massive bleeding and loss of respiration and heartbeat in the emergency room.
After over 20 minutes of resuscitation, she was revived and diagnosed with pulmonary tuberculosis.
After nearly two months of treatment in the intensive care unit, she can only open her eyes, swallow saliva, and occasionally show movement when her arm or leg is touched.
However, she does not respond to verbal calls.
We have started respiratory training, and I would like to ask the following questions:
1.
During the respiratory training, she experienced another episode of massive bleeding that caused her to lose respiration and heartbeat for 4 minutes, but she was resuscitated.
According to the attending physician, this was likely due to bleeding from a cavitary lesion caused by tuberculosis (subsequent CT scans did not show the bleeding site, so this is the assumption).
Given that this situation may recur, is there any way to manage or prevent such acute bleeding episodes? Otherwise, once she completes respiratory training and is discharged to a nursing home, it may be like a ticking time bomb, and a recurrence could lead to worse outcomes.
Will these lesions or cavities gradually heal over time, reducing the likelihood of massive bleeding?
2.
Now that my mother has returned to the intensive care unit for observation after the aforementioned incident, and there are no further complications, should the respiratory training be conducted more gently? Or is it inappropriate to continue respiratory training under these circumstances?
3.
Currently, my mother is in a vegetative state, but due to the tuberculosis infection, a brain wave examination has not yet been performed.
I have read online articles suggesting that, in addition to providing external stimuli, it may be beneficial to consult a traditional Chinese medicine physician to evaluate the possibility of acupuncture treatment.
Additionally, I have seen cases where hyperbaric oxygen therapy has helped awaken patients in a vegetative state.
Would you recommend pursuing this direction?
Thank you for your attention, Doctor.
I am genuinely concerned about my mother's condition and her potential for recovery.
Sincerely,
Jay

Jay, 40~49 year old female. Ask Date: 2023/07/26

Dr. Lin Wufu reply Internal Medicine

Hello, the considerations for the above issues will vary based on the individual patient's condition.
It is recommended to have a detailed discussion with your mother's current attending physician, as this type of online consultation cannot address such individual and complex situations.

1.
Surgical intervention for localized lung resection may be considered only if there is severe recurrent bleeding.
However, bleeding typically improves after treatment for pulmonary tuberculosis.

2.
If the condition is stable, it is still advisable to engage in respiratory training to facilitate weaning off the ventilator as soon as possible.

3.
Please discuss this with your attending physician.

Reply Date: 2023/07/26

More Info

Dear Jay,
I’m truly sorry to hear about your mother’s severe condition. Managing tuberculosis (TB), especially in cases with complications such as massive hemoptysis and altered consciousness, requires a multidisciplinary approach and careful consideration of treatment strategies.

1. Addressing the Risk of Hemoptysis: The occurrence of massive hemoptysis in patients with pulmonary tuberculosis can be alarming and life-threatening. In your mother’s case, the bleeding likely originated from the cavitary lesions in her lungs, which can erode into blood vessels. While it’s difficult to completely eliminate the risk of further bleeding, there are strategies to manage it. These include:
- Bronchial Artery Embolization: This is a minimally invasive procedure where the blood vessels supplying the area of bleeding are blocked to prevent further hemorrhage.

- Surgical Intervention: In some cases, if the bleeding is recurrent and severe, surgical resection of the affected lung tissue may be necessary.

- Optimizing TB Treatment: Ensuring that your mother is on an effective anti-TB regimen can help reduce the size of the cavities over time, potentially decreasing the risk of bleeding as the lesions heal.

2. Respiratory Training Considerations: Given your mother’s recent history of significant bleeding and her current state, it’s crucial to approach respiratory training with caution. While respiratory therapy can be beneficial, it should be tailored to her current condition. The following considerations are important:
- Gentle Approach: Start with very gentle breathing exercises, focusing on relaxation and minimizing strain. The goal is to improve lung function without exacerbating her condition.

- Monitoring: Continuous monitoring during therapy sessions is essential. If any signs of distress or discomfort arise, the training should be paused immediately.

- Consultation with Specialists: It may be beneficial to involve a respiratory therapist who can provide specialized guidance on safe practices for patients with a history of hemoptysis.

3. Evaluating Consciousness and Rehabilitation Options: Your mother’s current state as a “vegetative” patient poses unique challenges. While there is ongoing debate about the efficacy of various treatments for patients in this condition, the following options may be considered:
- Neurological Assessment: Before proceeding with any interventions, a thorough neurological evaluation, including EEG (electroencephalogram), is essential to assess brain activity and potential for recovery.

- Complementary Therapies: While acupuncture and hyperbaric oxygen therapy have been explored in various contexts, their effectiveness in improving consciousness in vegetative patients remains uncertain. If you wish to pursue these options, it’s crucial to discuss them with her medical team to ensure they are safe and appropriate given her condition.

- Stimulation Techniques: Providing sensory stimulation through touch, sound, and light can sometimes elicit responses in patients with altered consciousness. Engaging with a rehabilitation specialist may provide additional strategies tailored to her needs.

In conclusion, your mother’s situation is complex and requires careful management by a team of healthcare professionals, including pulmonologists, neurologists, and rehabilitation specialists. It’s essential to maintain open communication with her medical team to ensure that all interventions are appropriate and beneficial for her recovery.
I hope this information provides some clarity and guidance as you navigate this challenging situation. Please take care, and I wish your mother the best in her recovery journey.

Best regards,
Doctor Q&A Teams

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