Sikeres extracorporalis membránoxigenizációs (ECMO-) kezelés Legionella-pneumoniában
| Autor: | Jenő Elek, Ilona Bobek, Nóra Schönauer, Ildikó Madurka, Krisztina Kormosói-Tóth, Tibor Bartók |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
ARDS
business.industry medicine.medical_treatment Legionella Pneumonia General Medicine medicine.disease Hypoxemia Sepsis 03 medical and health sciences Pneumonia 0302 clinical medicine Intensive care Anesthesia Extracorporeal membrane oxygenation medicine Breathing 030211 gastroenterology & hepatology medicine.symptom business |
| Zdroj: | Orvosi Hetilap. 160:235-240 |
| ISSN: | 1788-6120 0030-6002 |
| Popis: | Abstract: The mortality of severe ARDS is almost 60%. Ventilation-associated lung-injury can be avoided by low-pressure, low-volume ventilation. Potential use of ECMO in case of refractory hypoxemia beside modern ventilatory therapy can be considered. Increasing numbers of respiratory ECMO runs are seen worldwide, though the efficacy remains controversial. The authors present the first successful venovenous-ECMO treatment in severe ARDS in our Institute. We report the case of a 67-year-old male who was admitted with community-acquired pneumonia caused by Legionella. Despite empirical and later targeted antibiotic therapy, severe ARDS with sepsis evolved. Neither ventilation nor prone position resulted in permanent improvement in oxygenation. The patient was referred to our Institute for extracorporeal life support (ECLS) therapy. On admission, blood gas showed severe hypoxemia with mild hypercapnia (PaO2/FiO2: 60, pCO2: 53 mmHg at PEEP: 14 mmHg, PIP: 45 mmHg). X-ray showed bilateral patchy infiltrates while cardiac impairment (EF: 45%) and dilated right ventricle were seen on echocardiography. Elevated pulmonary artery pressure (mPAP: 41 mmHg) was measured. After implantation of femoral-jugular VV ECMO, oxygen saturation was appropriate with lung protective ventilation (FiO2: 0.5, TV: 3–4 ml/kg). Improving lung function enabled us to stop ECMO after 8 days and further 5 days later the patient was weaned off ventilation. After 21 days of intensive care we discharged him to the referral hospital. By reporting this case we emphasise the potential role of respiratory ECMO. Consideration should be given to increase the contingent of this modality in the Hungarian intensive care in accordance with international practice. Orv Hetil. 2019; 160(6): 235–240. |
| Databáze: | OpenAIRE |
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