RESUMEN
Introduction: Venoarterial extracorporeal membrane oxygenation (ECMO) is a rescue therapy that can stabilize patients with hemodynamic compromise. Indications continue to evolve, including drug overdose. However, the indication merely for vasoplegic shock following drug overdose is controversial. Case summary: We report a case of a 57-year-old male with high-risk idiopathic pulmonary arterial hypertension treated with upfront triple combination therapy (sildenafil, bosentan, and intravenous treprostinil infusion via subcutaneous abdominal implantable pump). In one of the refills of the drug reservoir, accidental administration of 1 months's supply of treprostinil (200â mg) into the subcutaneous tissue occurred, causing refractory vasoplegic shock. He required urgent VA-ECMO for 96â h, surviving to discharge 28 days later. Discussion: Treprostinil poisoning is rare due to its less frequent use but is life-threatening. ECMO may be considered in vasoplegic shock due to overdose of vasodilatory medication. It allows organ perfusion to be maintained, with the knowledge that recovery is as rapid as drug elimination.
RESUMEN
We present a 67-year-old male with amyotrophic lateral sclerosis (ALS) who developed left lower lobe atelectasis and respiratory failure caused by a large pneumoperitoneum after gastrostomy placement. The patient was successfully managed with paracentesis, postural measures, and continued application of noninvasive positive pressure ventilation (NIPPV). There is no clear evidence that links the use of NIPPV with an increased risk of pneumoperitoneum. The evacuation of air from the peritoneal cavity may help improve the respiratory mechanics in patients with diaphragmatic weakness such as the one presented.
