Accidental placement of venous return catheter in the superior vena cava during venovenous extracorporeal membrane oxygenation for severe pneumonia: A case report.

BACKGROUND: Venovenous extracorporeal membrane oxygenation (V-V ECMO) has become an important treatment for severe pneumonia, but there are various complications during the treatment. This article describes a case with severe pneumonia successfully treated by V-V ECMO, but during treatment, the retrovenous catheter, which was supposed to be in the right internal vein, entered the superior vena cava directly in the mediastinum. The ECMO was safely withdrawn after multidisciplinary consultation. Our experience with this case is expected to provide a reference for colleagues who will encounter similar situations. CASE SUMMARY: A 64-year-old man had severe pulmonary infection and respiratory failure. He was admitted to our hospital and was given ventilation support (fraction of inspired oxygen 100%). The respiratory failure was not improved and he was treated by V-V ECMO, during which the venous return catheter, which was supposed to be in the right internal vein, entered the superior vena cava directly in the mediastinum. There was a risk of massive mediastinal bleeding if the catheter was removed directly when the ECMO was withdrawn. Finally, the patient underwent vena cava angiography + balloon attachment + ECMO withdrawal in the operating room (prepared for conversion to thoracotomy for vascular exploration and repair at any time during surgery) after multidisciplinary consultation. ECMO was safely withdrawn, and the patient recovered and was discharged. CONCLUSION: Patients may have different vascular conditions. Multidisciplinary cooperation can ensure patient safety. Our experience will provide a reference for similar cases.

Thrombotic thrombocytopenic purpura (TPP) successfully rescued by plasma exchange in the ICU: A report of two cases.

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening disorder, which is characterized by thrombus formation in small blood vessels. The present study retrospectively analyzed the clinical data from two patients with severe TTP, who were treated successfully in the intensive care unit (ICU) at the Liaocheng People's Hospital in 2013. Comprehensive therapies were administered to the patients, including plasma exchange (PE), mechanical ventilation (case 1 only), steroid therapy, blood transfusion and anti-inflammatory treatment (case 2 only). The two patients returned to a stable state and were transferred back to the hematology department following PE. The positive outcome achieved for these patients suggests that early intervention involving bedside PE in the ICU may reduce the mortality rate of patients with severe TTP who have concurrent respiratory or circulatory failure and cannot be treated in the dialysis unit.

[Clinical study of cerebral oxygen utilization coefficients in patients with severe head injury].

OBJECTIVE: To investigate the relationship in cerebral oxygen utilization coefficients (O.2UCc) in patients with acute severe head injury and illness prognosis. METHODS: Forty patients with acute severe head injury were studied, and 40 patients with light head injury were used as control. Through blood analysis, the changes in oxygen saturation of carotid blood (SaO(2)), oxygen saturation of jugular blood (SjO(2)), cerebral arteriovenous difference of oxygen saturation (S(a-j)O(2)), O.2 UCc were observed. Furthermore, the relationship of these patients' condition and prognosis was analyzed. RESULTS: There was no significant change between the test group and control group in SaO(2). In test group, SjO(2) increased and O.2 UCc decreased, there was an obvious difference between two groups (both P<0.01). In test group, 26 died and 14 lived. There was no significant difference between died and lived patients in SaO(2). SjO(2) significantly increased and O.2 UCc obviously decreased in died patients in comparison with those of the lived patients (both P<0.01). CONCLUSION: Cerebral oxygen metabolism dynamics obstacle frequently was accompanied with acute severe head injury. The high SjO(2) and low O.2 UCc are main symptoms with O.2 UCc<11percent hinting a bad prognosis.

[Relationship between blood NO and PaO2 or PaCO2 levels of patients with acute carbon monoxide poisoning].

OBJECTIVE: To investigate the relationship between blood nitrogen monoxide(NO) and PaO2 or PaCO2 levels in patients with severe and moderate acute carbon monoxide poisoning. METHOD: The blood levels of NO in patients with severe and moderate acute carbon monoxide poisoning was assayed with nitrate reductase method, and its correlation with the blood levels of PaO2 and PaCO2 was analyzed. RESULTS: The blood level of NO in patients with severe and moderate acute carbon monoxide poisoning were (36.6 +/- 9.9) and (35.7 +/- 10.7) mumol/L respectively, significantly lower than that of control group[(64.9 +/- 14.3) mumol/L, P < 0.01], but there was no significant difference between moderate and severe patients(P > 0.05). The analysis of linear correlation showed that there was significant positive correlation between NO and PaO2 but not PaCO2. CONCLUSION: Anoxia of patients with acute carbon monoxide poisoning may be an important cause to reduce NO level in blood. This study provides the basis for low NO concentration inhalation in treatments of acute carbon monoxide poisoning.