RESUMEN
BACKGROUND: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an effective rescue therapy for improving oxygenation in selected severe acute respiratory distress syndrome (ARDS). Prone position (PP) is usually considered before vvECMO and few data are available on the association of PP during VV-ECMO. Thus, we investigated the effect on oxygenation and the safety of PP during vvECMO. METHODS: During a two-year period, 15 patients with severe ARDS were turned into PP during VV-ECMO therapy for at least one of the three following conditions: severe hypoxemia (PaO2/FiO2 ratio below 70) despite maximal oxygenation, injurious ventilation parameters with plateau pressure exceeding 32 cmH2O or failure of attempt to wean ECMO after at least 10 days on ECMO support. RESULTS: PP was considered after a median of 9 days of ECMO and applied for a median of 12 hours and an average of 1.4 sessions per patient resulting in a total of 21 procedures. We found significant improvement in PaO2/FiO2 ratio at 6 hours (P=0.03) and 12 hours (P=0.007) after reversal. The improvement in oxygenation has still persisted 1hour (P=0.017) and 6 hours (P=0.013) after back to the supine position. No change in PaCO2, respiratory system (RS) compliance was observed. ECMO flow was maintained constant during the procedure. No complication related to PP was detected. CONCLUSION: PP may be considered in selected patients difficult to wean or remaining very hypoxemic despite VV-ECMO support.
Asunto(s)
Oxigenación por Membrana Extracorpórea/métodos , Posicionamiento del Paciente/métodos , Posición Prona/fisiología , Síndrome de Dificultad Respiratoria/terapia , Adulto , Anciano , Cuidados Críticos/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
Phaeochromocytoma and paraganglioma are chromaffine tumours secreting catecholamines. They are usually revealed by a paroxystic hypertensive crisis associated with headaches, palpitation and sweats. We reported a case of a young patient presenting a state of life threatening cardiogenic shock as unusual revelation of this tumour, requiring the implementation of an extracorporeal life support until myocardial recovery.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/complicaciones , Neoplasias de las Glándulas Suprarrenales/metabolismo , Circulación Asistida , Catecolaminas/metabolismo , Paraganglios Cromafines/metabolismo , Paraganglioma/complicaciones , Choque Cardiogénico/terapia , Adolescente , Neoplasias de las Glándulas Suprarrenales/cirugía , Antagonistas de Dopamina , Electrocardiografía , Femenino , Hemodinámica/fisiología , Humanos , Complicaciones Intraoperatorias/diagnóstico por imagen , Complicaciones Intraoperatorias/terapia , Metoclopramida , Paraganglioma/metabolismo , Paraganglioma/cirugía , Feocromocitoma/complicaciones , Choque Cardiogénico/diagnóstico por imagen , Choque Cardiogénico/etiología , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
We report a case of Lemierre's syndrome complicated with pulmonary septic abscesses, leading to necrotizing pneumonia. In spite of administration of appropriate antibiotics and a protective ventilation strategy, the patient had several bilateral pneumothoraces. In this setting, the mechanical ventilation was unsuccessful leading to two hypoxia-related cardiac arrests. An extracorporeal CO(2) removal was then carried out for 34-days duration. The patient was weaned from mechanical ventilation on day 68. He was then transferred to the chest surgery unit on day 83.
