Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Cardíacas/secundário , Neoplasias Renais/diagnóstico por imagem , Cuidados Paliativos/métodos , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Inibidores da Angiogênese/uso terapêutico , Anticoagulantes/uso terapêutico , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/patologia , Feminino , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/tratamento farmacológico , Heparina/uso terapêutico , Humanos , Indazóis , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/patologia , Pessoa de Meia-Idade , Pirimidinas/uso terapêutico , Radiografia Torácica , Sulfonamidas/uso terapêutico , Insuficiência da Valva Tricúspide/patologia , Carga TumoralRESUMO
A 49-year-old man presented to the emergency department with acute-onset dyspnoea and hypoxaemia 1 day following nasal surgery for obstructive sleep apnoea. A chest X-ray showed diffuse bilateral pulmonary infiltrates. Supplemental 100% fractional inspired oxygen (FiO2) via non-rebreather mask was delivered with resulting arterial oxygen tension:FiO2 ratio of 67. Transthoracic echocardiogram demonstrated normal heart function. A clinical diagnosis of severe acute respiratory distress syndrome (ARDS) was promptly made. Based on patient preference to avoid intubation and following a multidisciplinary approach, we decided to initiate venovenous extracorporeal membrane oxygenation (VV-ECMO) as an alternative strategy to mechanical ventilation. Though he ultimately required brief mechanical ventilation during ECMO cannulation, the patient spent a total of 5 days on VV-ECMO and a total of 8 days in the intensive care unit. Six days after discharge, his pulmonary function test demonstrated no significant abnormalities. We present a rare case of early initiation of VV-ECMO in a patient with severe ARDS that served as a bridge to recovery.