Favourable outcome after prolonged veno-venous extracorporeal membrane oxygenation (V-V ECMO) support for Pneumocystis jirovecii pneumonia in a renal transplant recipient

2021 ◽  
Vol 14 (4) ◽  
pp. e240004
Author(s):  
Daniel Kleinloog ◽  
Jacinta Maas ◽  
Jorge Lopez Matta ◽  
Carlos Elzo Kraemer
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Favourable Outcome ◽  
Pneumocystis Jirovecii ◽  
Lung Protective Ventilation ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Partial Recovery ◽  
Ventilation Strategy ◽  
Membrane Oxygenation ◽  
Protective Ventilation Strategy ◽  
History Of

A 27-year-old man, with a history of renal transplantation, presented with acute kidney failure and Pneumocystis jirovecii pneumonia. The patient developed severe acute respiratory failure and required support by veno-venous extracorporeal membrane oxygenation for a total of 59 days. During this period, the patient had extremely low tidal volumes using a lung protective ventilation strategy and intermittent prone positioning was used to optimise oxygenation. There was full recovery of pulmonary and partial recovery of renal function.

scholarly journals Endobronchial One-Way Valve Therapy Facilitates Weaning from Extracorporeal Membrane Oxygenation in a Patient with ARDS and Persistent Air Leak

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Alessandro Ghiani ◽  
Matthias Hansen ◽  
Konstantinos Tsitouras ◽  
Claus Neurohr
Keyword(s):  
Mechanical Ventilation ◽  
Extracorporeal Membrane Oxygenation ◽  
Practical Knowledge ◽  
Left Lung ◽  
Clinical Problem ◽  
Lung Protective Ventilation ◽  
Air Leak ◽  
Membrane Oxygenation ◽  
Protective Ventilation Strategy ◽  
Persistent Air Leak

Prolonged pulmonary air leak (PAL) is a common clinical problem, associated with significant morbidity and mortality. There are numerous reports of treatment of PAL using endobronchial valves (EBV) in respiratory stable patients, but only few reports on critically ill patients, and there is virtually no practical knowledge in the treatment of PAL in mechanically ventilated patients with acute respiratory distress syndrome (ARDS), treated with veno-venous extracorporeal membrane oxygenation (vvECMO). We describe a case where EBV placement was performed in a patient with ARDS and PAL, treated with mechanical ventilation and vvECMO. Despite a lung protective ventilation strategy, a persistent air leak along with a large left-sided pneumothorax was observed. After bronchoscopic localisation of the fistula, two endobronchial valves were inserted into the left upper lobe, leading to an immediate decrease in the air flow and reexpansion of the left lung. During the following two weeks, the patient was weaned from vvECMO, and after another three weeks, complete liberation from mechanical ventilation was accomplished. EBV placement seems to be a safe method even in the presence of coagulopathy and may facilitate mechanical ventilation and weaning from vvECMO in patients with ARDS and PAL.

scholarly journals Extracorporeal membrane oxygenation in Pneumocystis jirovecii pneumonia: outcome in HIV and non-HIV patients

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Jonathan Rilinger ◽  
Dawid L. Staudacher ◽  
Siegbert Rieg ◽  
Daniel Duerschmied ◽  
Christoph Bode ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Hiv Patients ◽  
Membrane Oxygenation

scholarly journals Extracorporeal Membrane Oxygenation for ARDS: Optimization of Lung Protective Ventilation

2018 ◽  
Vol 63 (9) ◽  
pp. 1180-1188 ◽  
Author(s):  
Madhavi Parekh ◽  
Darryl Abrams ◽  
Daniel Brodie ◽  
Natalie H Yip
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Membrane Oxygenation

scholarly journals Case Report. Extracorporeal Membrane Oxygenation in Nivolumab Associated Pneumonitis

2017 ◽  
Vol 3 (2) ◽  
pp. 84-88
Author(s):  
Thomas-Michael Schneider ◽  
Friederike Klenner ◽  
Franz Brettner
Keyword(s):  
Case Report ◽  
Extracorporeal Membrane Oxygenation ◽  
Therapeutic Option ◽  
High Dose ◽  
Great Success ◽  
Case Presentation ◽  
Computed Tomographic ◽  
Rehabilitation Hospital ◽  
Membrane Oxygenation ◽  
History Of

Abstract Background: Newly approved immunotherapeutic agents, like CTLA-4 inhibitors and antibodies against PD-1, are a promising therapeutic option in cancer therapy. Case presentation: A 74-year-old man, with a history of advanced stage melanoma and treatment with ipilimumab, pembrolizumab and nivolumab, was admitted to the hospital due to respiratory failure with hypoxemia and dyspnoea. He rapidly developed severe acute respiratory distress syndrome (ARDS), which required treatment in the intensive care unit which included mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Computed tomographic imaging (CT) showed signs of a pneumonitis, with an ARDS pattern related to the use of PD-1 antibodies. Treating the patient with high-dose immunosuppressive steroids led to an overall improvement. He was transferred to a rehabilitation hospital and subsequently to his home. Discussion and conclusion: This is a unique case report of a patient suffering a grade 4 adverse event under nivolumab who survived having been treated with ECMO. It highlights the possibility of associated adverse reactions as well as the use of ECMO in palliative care patients. ECMO can be of great success even in patients with malignancies, but careful decision making should be done on a case by case basis.

The Development of Extracorporeal Membrane Oxygenation

2018 ◽  
Vol 84 (4) ◽  
pp. 587-592 ◽  
Author(s):  
Don K. Nakayama
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Heart Surgery ◽  
Life Support ◽  
Open Heart Surgery ◽  
Newborn Infants ◽  
Open Heart ◽  
Older Children ◽  
Membrane Oxygenation ◽  
Ann Arbor ◽  
History Of

Evolving from the development of heart-lung machines for open-heart surgery, extracorporeal membrane oxygenation has reemerged as a rescue modality for patients with acute respiratory failure that cannot be supported by conventional modes of ventilation. The history of extracorporeal membrane oxygenation begins with the discovery of heparin, fundamental to the success of extracorporeal circulation and membrane lungs. Engineers and scientists created suitable artificial membranes that allowed gas exchange while keeping gas and blood phases separate. Special pumps circulated blood through the devices and into patients without damage to delicate red cells and denaturing plasma. Initial attempts in adults ended in failure, but Robert Bartlett, first at Loma Linda, CA, then at Ann Arbor, MI, succeeded in applying the technology in newborn infants with persistent pulmonary hypertension. Preserved in the critical care of infants, the technology in time could be reapplied in the life support of older children and adults.

scholarly journals Pneumocystis jirovecii Pneumonia in a HIV-Infected Patient with a CD4 Count Greater Than 400 Cells/μL and Atovaquone Prophylaxis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Abigayle Sullivan ◽  
Theresa Lanham ◽  
Ronald Krol ◽  
Shilla Zachariah
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Lung Biopsy ◽  
Cd4 Count ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Silver Stain ◽  
Highly Active ◽  
History Of ◽  
Methenamine Silver ◽  
Methenamine Silver Stain

We describe a rare case of Pneumocystis jirovecii pneumonia (PCP) in a heterosexual man with a pertinent medical history of well-controlled human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART) and PCP prophylaxis with atovaquone. The patient presented with recurrent shortness of breath, worsening malaise, and fever, following treatment for hypersensitivity pneumonitis one month prior, including a twenty-four-day course of 40 milligrams daily glucocorticoid with taper. However, transbronchial biopsies, lavage, and cytology from prior admission were inconclusive. The patient refused video-assisted thoracic surgery (VATS) at that time. Upon readmission, bronchoscopy with right VATS and lung biopsy were performed. Grocott’s methenamine silver stain of right lung biopsy was positive for Pneumocystis jirovecii. This case is a rare example of PCP in a patient with a normal CD4 count (>487 cells/μL) and a low viral load (<20 copies/mL) despite PCP prophylactic antibiotics in the setting of recent iatrogenic immunosuppression.

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