RESUMEN
Supporting homeostasis in a pregnant woman with brain death to achieve fetal viability is called somatic support. We present a case of young pregnant woman at 21 weeks' gestation who developed acute respiratory distress syndrome secondary to influenza A H2N3 infection requiring veno-venous extracorporeal membrane oxygenation (VV ECMO) support for refractory hypoxemia. The clinical course was complicated by intracranial hemorrhage and subsequent brain death. After multidisciplinary team discussion with her family, consensus was reached to continue somatic support with VV ECMO to enable fetal development to attain extrauterine viability. The challenging clinical, ethical, and legal concerns are discussed.
Asunto(s)
Oxigenación por Membrana Extracorpórea , Gripe Humana , Síndrome de Dificultad Respiratoria , Muerte Encefálica , Oxigenación por Membrana Extracorpórea/efectos adversos , Femenino , Humanos , Embarazo , Mujeres EmbarazadasRESUMEN
La oxigenación de membrana extracorpórea se considera una terapia de rescate y soporte vital compleja, con beneficios en enfermedades cardiorrespiratorias durante el periodo neonatal, que cumple con las características de ser reversible en recién nacidos mayores de 34 semanas. El criterio de selección de los pacientes y el momento oportuno en que se indica son críticos para el resultado final, si bien las nuevas alternativas de manejo en falla respiratoria hipoxémica en recién nacidos a término y casi a término han generado una disminución de su uso, excepto en la hernia diafragmática, que continúa siendo una enfermedad compleja donde podría tener alguna aplicabilidad. Si bien nuestra experiencia está iniciándose, el entrenamiento constante hará de la oxigenación de membrana extracorpórea una opción para pacientes complejos en quienes la terapia máxima fracasa. Se hace un informe de los primeros casos neonatales por falla respiratoria hipoxémica manejados en la Fundación Cardiovascular de Colombia.
Extracorporeal membrane oxygenation is considered a rescue therapy and complex vital support with benefits in cardiorespiratory diseases during neonatal period that fulfil the characteristics of being reversible in neonates older than 34 weeks. The criteria for patient selection and its prompt use are critical for the final result. Even though new alternatives for management of hypoxemic respiratory failure in full term and almost full term neonates have decreased its use, congenital diaphragmatic hernia continues being a complex disease where it can have some applicability. Even though our experience is beginning, constant training will make of extracorporeal membrane oxygenation an option for complex patients in whom maximum therapy fails. This is a report of the first neonatal cases of hypoxemic respiratory failure managed at Fundación Cardiovascular de Colombia.
Asunto(s)
Femenino , Humanos , Recién Nacido , Masculino , Oxigenación por Membrana Extracorpórea/métodos , Hernias Diafragmáticas Congénitas/complicaciones , Síndrome de Aspiración de Meconio/complicaciones , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Insuficiencia Respiratoria/terapia , Infecciones Bacterianas/prevención & control , Colombia , Oxigenación por Membrana Extracorpórea/efectos adversos , Resultado Fatal , Hernias Diafragmáticas Congénitas , Selección de Paciente , Evaluación de Programas y Proyectos de Salud , Síndrome de Dificultad Respiratoria del Recién Nacido/etiología , Insuficiencia Respiratoria/etiologíaRESUMEN
Extracorporeal membrane oxygenation is considered a rescue therapy and complex vital support with benefits in cardiorespiratory diseases during neonatal period that fulfil the characteristics of being reversible in neonates older than 34 weeks. The criteria for patient selection and its prompt use are critical for the final result. Even though new alternatives for management of hypoxemic respiratory failure in full term and almost full term neonates have decreased its use, congenital diaphragmatic hernia continues being a complex disease where it can have some applicability. Even though our experience is beginning, constant training will make of extracorporeal membrane oxygenation an option for complex patients in whom maximum therapy fails. This is a report of the first neonatal cases of hypoxemic respiratory failure managed at Fundación Cardiovascular de Colombia.
