scholarly journals A Case of Leptospirosis-Associated Severe Pulmonary Hemorrhagic Syndrome Successfully Treated with Venovenous Extracorporeal Membrane Oxygenation

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Nao Umei ◽  
Shingo Ichiba
Keyword(s):  
Mechanical Ventilation ◽  
Extracorporeal Membrane Oxygenation ◽  
Serum Antibody ◽  
Arterial Oxygen ◽  
Membrane Oxygenation ◽  
History Of ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Fraction Of Inspired Oxygen ◽  
Paired Serum ◽  
Oxygen Ratio

Background. In patients with leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS), hypoxemia is the most common cause of death despite maximal mechanical ventilation. Case. A 50-year-old male sushi chef who had never traveled outside Japan presented with a 2-day history of fever and muscle pain. On admission, the patient had thrombocytopenia, renal insufficiency, and jaundice. His condition continued to deteriorate, with decreasing platelet count, worsening renal function, hyperbilirubinemia, hypotension, and respiratory distress. On day 5 after onset of symptoms, he required intubation and mechanical ventilation. Bronchoscopy showed diffuse endobronchial bleeding. His respiratory status worsened rapidly with a partial pressure of arterial oxygen to fraction of inspired oxygen ratio of 70, necessitating venovenous extracorporeal membrane oxygenation (V-V ECMO) and treatment with an inotrope, renal replacement therapy, and broad-spectrum antibiotics including benzylpenicillin. Anticoagulation was maintained at the minimum level. His condition improved, and he was weaned off ECMO on day 15 and discharged on day 19 after onset of symptoms. The leptospirosis diagnosis was confirmed by leptospiral DNA detection in urine samples by polymerase chain reaction and the results of paired serum antibody titer testing. Conclusions. V-V ECMO may prevent mortality in patients with leptospirosis-induced SPHS that does not respond to conventional therapy.

Rest ventilator management in children on veno-venous extracorporeal membrane oxygenation

2021 ◽  
pp. 039139882199938
Author(s):  
Matthew L Friedman ◽  
Samer Abu-Sultaneh ◽  
James E Slaven ◽  
Christopher W Mastropietro
Keyword(s):  
Mechanical Ventilation ◽  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Arterial Oxygen Saturation ◽  
Peak Inspiratory Pressure ◽  
Conventional Mechanical Ventilation ◽  
Arterial Oxygen ◽  
Multivariable Logistic Regression Analysis ◽  
Membrane Oxygenation ◽  
Ventilator Management

Background: We aimed to use the Extracorporeal Life Support Organization registry to describe the current practice of rest mechanical ventilation setting in children receiving veno-venous extracorporeal membrane oxygenation (V-V ECMO) and to determine if relationships exist between ventilator settings and mortality. Methods: Data for patients 14 days to 18 years old who received V-V ECMO from 2012-2016 were reviewed. Mechanical ventilation data available includes mode and settings at 24 h after ECMO cannulation. Multivariable logistic regression analysis was performed to determine if rest settings were associated with mortality. Results: We reviewed 1161 subjects, of which 1022 (88%) received conventional mechanical ventilation on ECMO. Rest settings, expressed as medians (25th%, 75th%), are as follows: rate 12 breaths/minute (10, 17); peak inspiratory pressure (PIP) 22 cmH2O (20,27); positive end expiratory pressure (PEEP) 10 cmH2O (8, 10); and fraction of inspired oxygen (FiO2) 0.4 (0.37, 0.60). Survival to discharge was 68%. Higher ventilator FiO2 (odds ratio:1.13 per 0.1 increase, 95% confidence interval:1.04, 1.23), independent of arterial oxygen saturation, was associated with mortality. Conclusions: Current rest ventilator management for children receiving V-V ECMO primarily relies on conventional mechanical ventilation with moderate amounts of PIP, PEEP, and FiO2. Further study on the relationship between FiO2 and mortality should be pursued.

scholarly journals Early Tracheostomy for ARDS Patients Supported by Venovenous Extracorporeal Membrane Oxygenation Is Associated With A Decreased Incidence of Ventilator-Associated Pneumonia, Duration of Extracorporeal Membrane Oxygenation and Mechanical Ventilation: Experience From A Single-Center Retrospective Cohort.

2021 ◽  
Author(s):  
Zeyu Zhang ◽  
Sichao Gu ◽  
Xu Huang ◽  
Jingen Xia ◽  
Fang Lin ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Retrospective Cohort ◽  
Ecmo Support ◽  
Ventilator Associated Pneumonia ◽  
Icu Mortality ◽  
Early Tracheostomy ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation

Abstract Background: Venovenous extracorporeal membrane oxygenation (ECMO) has become the ultimate supporting technique for the rescue of severe acute respiratory distress syndrome (ARDS) patients. Although tracheostomy during ECMO has proven to be beneficial, the proper time point for performing the tracheostomy remains unclear. The purpose of our study was to demonstrate whether early tracheostomy (ET; within 7 days of ECMO initiation) outweighs delayed tracheostomy (DT; 8 days of more after ECMO initiation).Methods: A retrospective cohort study was established. All ARDS patients who underwent tracheostomy during V-V ECMO support in the intensive care unit (ICU) of a tertiary hospital from December 2013 to November 2020 were reviewed.Results: Of the 187 ARDS patients who received V-V ECMO support, 30 (16%) underwent tracheostomy—18 (60%) during ECMO support and the other 12 after ECMO decannulation. Among the 18 patients who underwent tracheostomy while receiving ECMO, 11 (61.1%) received ET, and 7 received DT. No significant difference was found between the ET and DT groups in terms of demographic data, medical history, disease severity (estimated based on the RESP, PRESERVE, APACHE Ⅱ, SOFA and Murray scores), ARDS risk factors or mechanical ventilation duration before ECMO. The ET group showed a decreased incidence of ventilator-associated pneumonia (VAP) during ECMO support (45.5% vs. 100%; P= 0.038) and shortened durations of ECMO (9.0 vs. 27.0 days; P= 0.011) and mechanical ventilation (16.0 vs. 56.0 days; P= 0.027). ET did not significantly alter the all-cause ICU mortality rate (54.5% vs. 28.6%; P= 0.367), all-cause hospital mortality rate (which was the same as the ICU mortality rate), length of ICU stay (336 vs. 627 hours; P= 0.085), or length of hospital stay (26 vs. 37 days; P= 0.285). Local bleeding at the tracheostomy wound did not differ between the two groups (27.3% vs. 42.9%, P= 0.627) .Conclusion: Compared with delayed tracheostomy, ET performed within 7 days of ECMO cannulation for severe ARDS patients could decrease the VAP incidence during ECMO support and shorten the durations of ECMO and mechanical ventilation; However, it may not improve the outcome. Prospective and multicenter studies are needed for further research.

scholarly journals Early initiation of venovenous extracorporeal membrane oxygenation in a mechanically ventilated patient with severe acute respiratory distress syndrome

2018 ◽  
pp. bcr-2018-226223 ◽  
Author(s):  
Nisha Krishnakant Raiker ◽  
Hector Cajigas
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Early Initiation ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Vv Ecmo

A 49-year-old man presented to the emergency department with acute-onset dyspnoea and hypoxaemia 1 day following nasal surgery for obstructive sleep apnoea. A chest X-ray showed diffuse bilateral pulmonary infiltrates. Supplemental 100% fractional inspired oxygen (FiO2) via non-rebreather mask was delivered with resulting arterial oxygen tension:FiO2 ratio of 67. Transthoracic echocardiogram demonstrated normal heart function. A clinical diagnosis of severe acute respiratory distress syndrome (ARDS) was promptly made. Based on patient preference to avoid intubation and following a multidisciplinary approach, we decided to initiate venovenous extracorporeal membrane oxygenation (VV-ECMO) as an alternative strategy to mechanical ventilation. Though he ultimately required brief mechanical ventilation during ECMO cannulation, the patient spent a total of 5 days on VV-ECMO and a total of 8 days in the intensive care unit. Six days after discharge, his pulmonary function test demonstrated no significant abnormalities. We present a rare case of early initiation of VV-ECMO in a patient with severe ARDS that served as a bridge to recovery.

scholarly journals A 92 Days Run of Venovenous Extracorporeal Membrane Oxygenation

2020 ◽  
Vol 4 (02) ◽  
pp. 147-152
Author(s):  
Manoj Kumar Sahu ◽  
Chalattil Bipin ◽  
Sourabh Pahuja ◽  
Sarvesh Pal Singh ◽  
Vijay Hadda
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress ◽  
Lessons Learned ◽  
Apnea Test ◽  
Membrane Oxygenation ◽  
Arterial Blood ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Vv Ecmo

Abstract Background Venovenous extracorporeal membrane oxygenation (VV-ECMO) is an established life-saving procedure for severe acute respiratory failure due to various causes. In general, the duration of ECMO ranges from 1 to 2 weeks, with withdrawal recommended if no improvement is noted. We report a case of respiratory failure due to acute respiratory distress syndrome (ARDS) following influenza A infection, supported with a long ECMO run and the lessons learned from this experience. Case Report A 40-year-old female weighing 120 kg with pneumonia following H1N1 influenza was transferred to our hospital on mechanical ventilation for worsening respiratory distress. On admission, she presented with bilateral diffuse infiltrates on chest X-ray and severe hypoxemia with a partial pressure of oxygen in arterial blood/fraction of inspired oxygen concentration ratio (PaO2/FiO2) of 85 at FiO2 of 0.8 on endotracheal intubation and mechanical ventilation. Acinetobacter Baumannii was isolated from respiratory secretions; antibiotics were revised as per sensitivity. Her respiratory status further deteriorated over next 96 hours in spite of maximally optimized mechanical ventilation. VV-ECMO was established on 4th day of mechanical ventilation in our hospital. Thereafter, she underwent a prolonged ECMO run with respiratory improvement starting to show some promise only by 86th day of ECMO. Weaning process was initiated gradually. However, on 88th day of ECMO the patient had an episode of seizure followed by low Glasgow Coma Scale (GCS) score (3T/15). The patient did not recover from the cerebral insult and based on clinical neurological examination including apnea test, brain death was determined within next 48 hours and the ECMO was called off. Conclusions Prolonged ECMO therapy poses many challenges and might be considered if the primary cause of respiratory failure necessitating ECMO is expected to resolve or a feasibility of lung transplantation is contemplated. Good team dynamics and appropriate counselling to the family are of utmost importance managing the patients on prolonged ECMO.

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