Long term extracorporeal membrane oxygenation therapy for H1N1 influenza related acute respiratory distress syndrome and several complications

Yıl 2018, Cilt: 2 Sayı: 3, 367 - 369, 01.09.2018

Behiye Deniz Kosovalı , Fatma İrem Yeşiler , Tülay Tunçer Peker Mustafa Kemal Bayar

https://doi.org/10.28982/josam.420716

Öz

Extracorporeal membrane oxygenation (ECMO) has significantly advanced in recent years. During the 2009 H1N1 influenza a pandemic, the use of venovenous (VV) ECMO represented a successful rescue treatment for acute respiratory distress syndrome (ARDS) in patients failing conventional ventilation techniques. The patient was thirty nine year-old and 38 weeks pregnant who had a seizure and then aspiration pneumonia occurred. Due to respiratory failure and hemodynamic instability she was intubated and vasopressor agent was initiated. Her chest X ray showed bilateral nonhomogeneous opacity; hence she was diagnosed with severe ARDS and septic shock. VVECMO was applied by a cardiovascular surgery team and the patient was transferred with the ECMO from hospital to our institution. During her hospitalization, multiple complications occurred, such as pneumothorax, critical illness polyneuropathy, clinical illness myopathy, oxygenator clotting and she was treated successfully.

Anahtar Kelimeler

Acute respiratory distress syndrome, Respiratory failure, Intensive care unit, Extracorporal membrane oxygenator

H1N1 influenza ilişkili akut respiratuar distres sendromunda uzun dönem ekstrakorporeal membran oksijenatör tedavisi ve birçok komplikasyon

Öz

Ekstrakorporeal membrane oksijenatörü (ECMO) son yıllarda oldukça gelişmiştir. 2009’daki H1N1 influenza pandemisi sırasında konvansiyonel ventilasyon tekniklerinin başarısız olduğu akut respiratuar distress sendromlu (ARDS) hastalarda venovenöz (VV) ECMO’nun başarılı bir tedavi olduğu gösterildi. Yirmi dokuz yaşında, 38 hafta gebe hastada sezaryen ile doğum sonrası aspirasyon pnömonisi gelişti. Solunum yetmezliği ve hemodinamik instabilite nedeniyle entübe edildi ve vazopresör ajan başlandı. Akciğer grafisinde bilateral nonhomojenöz opasite artışı gözlendi; bu sebeple ARDS ve septik şok tanısı aldı. VVECMO kardiyovasküler cerrahi ekibi tarafından kuruldu ve hasta ECMO ile hastanemize transfer edildi. Hastanede yatışı süresince pnömotoraks, kritik hastalık polinöropatisi, kritik hastalık myopatisi, oksijenatörün pıhtılaşması gibi birçok komplikasyon ortaya çıktı ve hasta başarı ile tedavi edildi. 

Anahtar Kelimeler

Akut respiratuar distress sendromu, Solunum yetmezliği, Yoğun bakım ünitesi, Ekstrakorporal membran oksijenatörü

Kaynakça

• 1. Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, et al. Pandemic Influenza A (H1N1) Virus Hospitalizations Investigation Team. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med. 2009;361(20):1935–44.
• 2. Jaber S, Conseil M, Coisel Y, Jung B, Chanques G. ARDS and influenza A (H1N1): patients’ characteristics and management in intensive care unit. Ann Fr Anesth Reanim. 2010;29(2):117–25.
• 3. Hill JD, O'Brien TG, Murray JJ, et al. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med. 1972;286:629-34.
• 4. Peek GJ, Clemens F, Elbourne D, Firmin R, Hardy P, Hibbert C, et al. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure. BMC Health Services Resarch. 2006;6:163.
• 5. ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definitio. JAMA. 2012 Jun 20;307(23):2526-33.
• 6. Extracorporeal Life Support Organization: ELSO Guidelines for Cardiopulmonary Extracorporeal Life Support. Version 1.1. Ann Arbor, MI, April 2009.
• 7. Zwischenberger JB, Bartlett RH. Management of blood flow and gas exchange during ECLS, in ECMO Extracorporeal Cardiopulmonary Support in Critical Care. 4th ed. Ann Arbor, MI: ELSO, 2012;149–56.
• 8. Makdisi G, Wang I. Extra corporeal membrane oxygenation (ECMO) review of a lifesaving technology. J Thorac Dis. 2015;7(7):E166-E76.
• 9. Huh JW. Update on the extracorporeal life support. Tuberc Respir Dis. 2015;78:149-55.
• 10. Lucchini A, De Felippis C, Elli S, Gariboldi R, Vimercati S, Tundo P, et al. Mobile ECMO team for inter-hospital transportation of patients with ARDS: a retrospective case series. Heart Lung and Vessels. 2014;6(4):262-73.
• 11. Guervilly C, Hraiech S, Gariboldi V, et al. Prone during veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adults. Minerve Anestesiol. 2014;80:307-12.
• 12. Herman G, Jonghe B, Brunyninckx F, Van den Berghe G. Clinical review: Critical illness polyneuropathy and myopathy. Critical Care. 2008;12:238.
• 13. Zebuhr C, Sinha A, Skilman H, Buckvold S. Active rehabilitation in pediatric extracorporeal membrane oxygenation patient. PMR. 2014;6;456-60.