1887
Volume 2017, Issue 1
  • ISSN: 0253-8253
  • E-ISSN: 2227-0426

Abstract

Extracorporeal membrane oxygenation (ECMO) has evolved as a treatment option for patients having rev ersible severe respiratory failure who are deter iorating on conventional ventilation.1,2 We describe our experience with a patient who received ECMO for refractory hypoxemic respiratory failure due to community-acquired pneumonia associated with systemic lupus erythematosus (SLE). This is a retrospective case report for which approval for presentation has been obtained from the administration of the department and can be submitted upon request. Our patient was an 18-year-old female with a long history of SLE with nephritis who was recently started on immunosuppression, admitted with azotemia, fluid overload, and respiratory failure, and initially improved with fluid removal.3 Her respiratory status later worsened with saturations in the low 80s despite 100% FiO and a positive end-expiratory pressure (PEEP) of 14 cm HO. She had a trial of prone positioning together with PEEP optimization, but her condition continued to deteriorate.4 The patient was evaluated for rescue ECMO therapy as a life-saving measure.5 Both femoral veins were cannulated, and when ECMO started, there was immediate improvement in oxygenation. The ventilator was soon switched to the pressure control setting (PEEP 10 cm HO/inspiratory pressure 10 cm HO/rate 10 cycles/min) with 40% FiO. The patient's hospital stay was complicated by lupus-induced thrombocytopenia, resulting in our decision to run heparin-free ECMO. She was decannulated after 25 days of ECMO without receiving any systemic anticoagulation. The patient improved and was decannulated, extubated, and discharged from hospital, with no residual lung comorbidity. ECMO without any systemic anticoagulation is an acceptable therapy when there is profound respiratory failure secondary to infection in an immunosuppressed patient.5 Most of the literature reviews have already shown the good application of ECMO in SLE-induced diffuse alveolar hemorrhage.6 Our case report presents a promising application of rescue ECMO therapy in a lupus-induced immunosuppressed patient with pneumonia, acute respiratory distress syndrome,7 and thrombocytopenia.

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/content/journals/10.5339/qmj.2017.swacelso.73
2017-02-14
2019-09-19
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http://instance.metastore.ingenta.com/content/journals/10.5339/qmj.2017.swacelso.73
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  • Article Type: Research Article
Keyword(s): ECMO , no systemic anticoagulation , systemic lupus erythematosus and thrombocytopenia
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