scholarly journals Lung Abscess with a Refractory Bronchopleural Fistula Saved from Potentially Fatal Sepsis by Omentoplasty and Extracorporeal Membrane Oxygenation

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Jumpei Takamatsu ◽  
Jinkoo Kang ◽  
Aya Fukuhara ◽  
Yuichi Yasue ◽  
Sae Kawata
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Bronchopleural Fistula ◽  
Lung Abscess ◽  
Positive Pressure ◽  
Air Leaks ◽  
Membrane Oxygenation ◽  
Thoracic Drainage ◽  
History Of ◽  
Fatal Sepsis ◽  
Adequate Oxygenation

Controlling air leaks during thoracic drainage in patients with lung abscesses caused by bronchopleural fistulas is challenging. To reduce the occurrence of air leaks, positive pressure ventilation should be avoided whenever possible. A 69-year-old man presented with a 10-day history of gradually worsening chest pain. He had lost consciousness and was brought to the emergency room. His SpO2 was approximately 70%, and his systolic blood pressure was approximately 60 mmHg. Chest radiography and computed tomography revealed findings suggestive of a right pyothorax. Therefore, thoracic drainage was performed. However, the patient’s respiratory status did not improve, and his circulatory status could not be maintained. Therefore, extracorporeal membrane oxygenation was introduced after the improvement in circulation by noradrenaline and fluid resuscitation, resulting in adequate oxygenation and ventilation without the use of high-pressure ventilator settings. Subsequently, omentoplasty for a refractory bronchopleural fistula was successfully performed, and the air leak was cured without recurrence of the lung abscess.

scholarly journals Early Extracorporeal Membrane Oxygenation in COVID-19 with Bullous Lung Disease on Mechanical Ventilation: A Case Report

2021 ◽  
Vol 5 (4) ◽  
pp. 425-428
Author(s):  
Jason Unold ◽  
Brandon Marshal ◽  
Tolupe Sonuyi
Keyword(s):  
Case Report ◽  
Extracorporeal Membrane Oxygenation ◽  
Tension Pneumothorax ◽  
Positive Pressure ◽  
Necrotizing Pneumonia ◽  
Viable Option ◽  
Lung Protection ◽  
Membrane Oxygenation ◽  
Potential Use ◽  
Adequate Oxygenation

Introduction: Extracorporeal membrane oxygenation (ECMO) has been well described as a viable option for patients in need of temporary supplemental oxygenation when ventilator capabilities have failed to augment a patient’s condition. Less described is the potential use of ECMO for lung protection in the setting of gigantic bullae despite initially adequate oxygenation. Case Report: We describe how the early incorporation of ECMO in a patient with coronavirus disease 2019 and necrotizing pneumonia complicated by multiple large and gigantic bullae led to a favorable outcome. Conclusion: The decision to start ECMO early, despite room for ventilator oxygenation adjustments, may have helped to prevent potential, significant complications such as tension pneumothorax while on positive pressure, thus potentially optimizing the outcome in this patient.

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.

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.

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.

Venovenous Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure

2016 ◽  
Vol 82 (9) ◽  
pp. 787-788 ◽  
Author(s):  
P. Benson Ham ◽  
Brice Hwang ◽  
Linda J. Wise ◽  
K. Christian Walters ◽  
Walter L. Pipkin ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Patients ◽  
Oxygenation Index ◽  
Lung Damage ◽  
Positive Pressure ◽  
Membrane Oxygenation ◽  
Short Run ◽  
Va Ecmo ◽  
Vv Ecmo

Conventional treatment of respiratory failure involves positive pressure ventilation that can worsen lung damage. Extracorporeal membrane oxygenation (ECMO) is typically used when conventional therapy fails. In this study, we evaluated the use of venovenous (VV)-ECMO for the treatment of severe pediatric respiratory failure at our institution. A retrospective analysis of pediatric patients (age 1–18) placed on ECMO in the last 15 years (1999–2014) by the pediatric surgery team for respiratory failure was performed. Five pediatric patients underwent ECMO (mean age 10 years; range, 2–16). All underwent VV-ECMO. Diagnoses were status asthmaticus (2), acute respiratory distress syndrome due to septic shock (1), aspergillus pneumonia (1), and respiratory failure due to parainfluenza (1). Two patients had severe barotrauma prior to ECMO initiation. Average oxygenation index (OI) prior to cannulation was 74 (range 23–122). No patients required conversion to VA-ECMO. The average ECMO run time was 4.4 days (range 2–6). The average number of days on the ventilator was 15 (range 4–27). There were no major complications due to the procedure. Survival to discharge was 100%. Average follow up is 4.4 years (range 1–15). A short run of VV-ECMO can be lifesaving for pediatric patients in respiratory failure. Survival is excellent despite severely elevated oxygen indices. VV-ECMO may be well tolerated and can be considered for severe pediatric respiratory failure.

scholarly journals Use of Emergency Department Extracorporeal Membrane Oxygenation for Treatment of Acute Necrotizing Myocarditis

2019 ◽  
Vol 3 (1) ◽  
pp. 47-50
Author(s):  
Carly Loner ◽  
Peter Crane
Keyword(s):  
Emergency Department ◽  
Extracorporeal Membrane Oxygenation ◽  
Rare Complication ◽  
High Morbidity ◽  
Membrane Oxygenation ◽  
Acute Necrotizing ◽  
History Of ◽  
Eosinophilic Myocarditis ◽  
Systemic Symptoms

We report a case of acute necrotizing eosinophilic myocarditis (ANEM) secondary to drug rash with eosinophilia and systemic symptoms (DRESS) related to administration of minocycline. Myocarditis is a rare complication of DRESS and can manifest as either a self-limited hypersensitivity myocarditis or as the frequently fatal ANEM. Due to the high morbidity and mortality caused by this disease, emergency physicians should be aware of the potential of ANEM in patients with history of DRESS and new-onset cardiac dysfunction. This case reviews the clinical presentation and management of ANEM and the potential role of extracorporeal membrane oxygenation use in the emergency department.

Successful slide tracheoplasty and partial atrioventricular septal defect repair following extracorporeal membrane oxygenation support

2014 ◽  
Vol 25 (3) ◽  
pp. 573-575 ◽  
Author(s):  
Eoin M. Kelleher ◽  
Lars Nolke ◽  
Colin J. McMahon
Keyword(s):  
Myocardial Infarction ◽  
Extracorporeal Membrane Oxygenation ◽  
Septal Defect ◽  
Atrioventricular Septal Defect ◽  
Membrane Oxygenation ◽  
Slide Tracheoplasty ◽  
Defect Repair ◽  
History Of ◽  
Background History ◽  
Operative Recovery

AbstractA two-year-old boy with a background history of Down syndrome and partial atrioventricular septal defect presented with acute respiratory distress requiring intubation and mechanical ventilation. He continued to deteriorate, despite ventilation; direct laryngoscopy, bronchoscopy, and computed tomography demonstrated severe long segment tracheal stenosis. He was placed on extracorporeal membrane oxygenation to stabilise his condition. A slide tracheoplasty and complete repair of the partial atrioventricular septal defect was successfully undertaken. His post-operative recovery was complicated by myocardial infarction and stroke but he made a full recovery. This represents the first report of slide tracheoplasty and partial atrioventricular septal defect repair in a child following extracorporeal membrane oxygenation support.

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