Pulmonary tuberculosis can lead to acute respiratory distress syndrome (ARDS) which is associated with high mortality. We report the case of a patient with pulmonary tuberculosis and severe ARDS (PaO2/FiO2<100 mmHg) who was initially managed with advanced up-to-date treatments (protective ventilation and extracorporeal membrane oxygenation, ECMO) but failed to improve. After a month of failure and the development of bilateral pneumothoraces, we drastically changed our therapeutic strategy: we maximized ECMO support to maintain oxygenation, we greatly reduced ventilation pressures and we left the pneumothoraces undrained. From then on, the patient improved and he eventually survived. This case suggests that ECMO permits large reductions in lung inflation and ventilation to rest the lungs, while maintaining acceptable oxygenation. The combination of ECMO and markedly attenuated ventilation strategy may be effective in cases of severe ARDS.
|Titolo:||Long-term extracorporeal membrane oxygenation with minimal ventilatory support : a new paradigm for severe ARDS?|
PESENTI, ANTONIO (Ultimo)
|Parole Chiave:||anticoagulants; antitubercular agents; blood transfusion; combined modality therapy; drainage; hemorrhage; heparin; humans; intensive care; male; nitric oxide; patient selection; pneumothorax; positive-pressure respiration; pressure; prone position; respiratory distress syndrome, adult; tuberculosis, pulmonary; young adult; extracorporeal membrane oxygenation|
|Settore Scientifico Disciplinare:||Settore MED/41 - Anestesiologia|
|Data di pubblicazione:||mar-2012|
|Appare nelle tipologie:||01 - Articolo su periodico|