Extending the limits of extracorporeal membrane oxygenation: lung rest for a child with non-specific interstitial pneumonia
Identifieur interne : 001E73 ( Main/Exploration ); précédent : 001E72; suivant : 001E74Extending the limits of extracorporeal membrane oxygenation: lung rest for a child with non-specific interstitial pneumonia
Auteurs : Iain Macintosh [Australie] ; Warwick W. Butt [Australie] ; Colin F. Robertson [Australie] ; Derek Best [Australie] ; Lara S. Shekerdemian [Australie]Source :
- Intensive Care Medicine [ 0342-4642 ] ; 2005-07-01.
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Abstract
Abstract: Objective: Veno-venous extracorporeal membrane oxygenation (ECMO) is an established therapy for the treatment of respiratory failure. Traditionally ECMO has been used to support patients with an acute, reversible disease process, with a predictable outcome. We report the successful use of veno-venous ECMO for an unusual indication. Patient: A 10-year old girl was admitted to intensive care with severe, hypoxic respiratory failure on the background of a 2-month history of worsening respiratory symptoms. She required high levels of conventional positive pressure ventilation, and high frequency oscillation. Lung biopsy confirmed a non-specific interstitial pneumonia, and the patient was commenced on immune suppressive therapy. Her clinical course was further complicated by pulmonary haemorrhage and severe air leak. Interventions: On day 20 after admission the patient was placed on veno-venous ECMO for lung rest while awaiting a response to continued medical treatment. She required ECMO for 20 days, during which time sedation was reduced, and she was able to interact with those around her. The patient’s ventilatory requirements after decannulation were minimal, and she subsequently made a steady clinical recovery. Conclusions: ECMO was safely and successfully used to provide a period of lung rest and time for medical therapy to take effect in a child with an unusual indication for support: a rare disease with an uncertain outcome on the background of prolonged mechanical ventilation.
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DOI: 10.1007/s00134-005-2620-6
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Robertson</name><affiliation wicri:level="1"><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Respiratory Medicine, The Royal Children’s Hospital, Flemington Road, 3052, Parkville, VIC</wicri:regionArea><wicri:noRegion>VIC</wicri:noRegion></affiliation></author><author><name sortKey="Best, Derek" sort="Best, Derek" uniqKey="Best D" first="Derek" last="Best">Derek Best</name><affiliation wicri:level="1"><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Paediatric Intensive Care, The Royal Children’s Hospital, Flemington Road, 3052, Parkville, VIC</wicri:regionArea><wicri:noRegion>VIC</wicri:noRegion></affiliation></author><author><name sortKey="Shekerdemian, Lara S" sort="Shekerdemian, Lara S" uniqKey="Shekerdemian L" first="Lara S." last="Shekerdemian">Lara S. Shekerdemian</name><affiliation wicri:level="1"><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Paediatric Intensive Care, The Royal Children’s Hospital, Flemington Road, 3052, Parkville, VIC</wicri:regionArea><wicri:noRegion>VIC</wicri:noRegion></affiliation><affiliation wicri:level="1"><country wicri:rule="url">Australie</country></affiliation></author></analytic><monogr></monogr><series><title level="j">Intensive Care Medicine</title><title level="j" type="abbrev">Intensive Care Med</title><idno type="ISSN">0342-4642</idno><idno type="eISSN">1432-1238</idno><imprint><publisher>Springer-Verlag</publisher><pubPlace>Berlin/Heidelberg</pubPlace><date type="published" when="2005-07-01">2005-07-01</date><biblScope unit="volume">31</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="993">993</biblScope><biblScope unit="page" to="996">996</biblScope></imprint><idno type="ISSN">0342-4642</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0342-4642</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Extracorporeal membrane oxygenation</term><term>Hypoxic respiratory failure</term><term>Lung rest</term><term>Non-specific interstitial pneumonia</term><term>Prolonged mechanical ventilation</term><term>Ventilator-associated lung injury</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Abstract: Objective: Veno-venous extracorporeal membrane oxygenation (ECMO) is an established therapy for the treatment of respiratory failure. Traditionally ECMO has been used to support patients with an acute, reversible disease process, with a predictable outcome. We report the successful use of veno-venous ECMO for an unusual indication. Patient: A 10-year old girl was admitted to intensive care with severe, hypoxic respiratory failure on the background of a 2-month history of worsening respiratory symptoms. She required high levels of conventional positive pressure ventilation, and high frequency oscillation. Lung biopsy confirmed a non-specific interstitial pneumonia, and the patient was commenced on immune suppressive therapy. Her clinical course was further complicated by pulmonary haemorrhage and severe air leak. Interventions: On day 20 after admission the patient was placed on veno-venous ECMO for lung rest while awaiting a response to continued medical treatment. She required ECMO for 20 days, during which time sedation was reduced, and she was able to interact with those around her. The patient’s ventilatory requirements after decannulation were minimal, and she subsequently made a steady clinical recovery. Conclusions: ECMO was safely and successfully used to provide a period of lung rest and time for medical therapy to take effect in a child with an unusual indication for support: a rare disease with an uncertain outcome on the background of prolonged mechanical ventilation.</div></front></TEI><affiliations><list><country><li>Australie</li></country></list><tree><country name="Australie"><noRegion><name sortKey="Macintosh, Iain" sort="Macintosh, Iain" uniqKey="Macintosh I" first="Iain" last="Macintosh">Iain Macintosh</name></noRegion><name sortKey="Best, Derek" sort="Best, Derek" uniqKey="Best D" first="Derek" last="Best">Derek Best</name><name sortKey="Butt, Warwick W" sort="Butt, Warwick W" uniqKey="Butt W" first="Warwick W." last="Butt">Warwick W. Butt</name><name sortKey="Robertson, Colin F" sort="Robertson, Colin F" uniqKey="Robertson C" first="Colin F." last="Robertson">Colin F. Robertson</name><name sortKey="Shekerdemian, Lara S" sort="Shekerdemian, Lara S" uniqKey="Shekerdemian L" first="Lara S." last="Shekerdemian">Lara S. Shekerdemian</name><name sortKey="Shekerdemian, Lara S" sort="Shekerdemian, Lara S" uniqKey="Shekerdemian L" first="Lara S." last="Shekerdemian">Lara S. Shekerdemian</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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