Abstract
We report a case of a 20-year-old male patient suffering from motorcycle accident complicated by rapid development of severe refractory hypoxemia and hypercapnia due to serious bilateral lung contusions and lacerations. Positive pressure mechanical ventilation induced pressure-dependent massive air leak from disrupted pulmonary tissue. Simultaneous implementation of veno-venous extracorporeal membrane oxygenation together with surfactant application allowed prolonged disconnection of patient from mechanical ventilation (“total lung rest” mode). Despite considerable areas of nonaerated tissue on computed tomography prior to the disconnection from mechanical ventilation, almost total functional recovery of lungs was eventually achieved.
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References
Kula R, Maca J, Sklienka P, Tichy J, Szturz P, Jahoda J, et al. Exogenous surfactant as a component of complex non-ECMO therapy of ARDS caused by influenza A virus (2009 H1N1). Bratisl Lek Listy. 2011;112:218–22.
Marhong JD, Telesnicki T, Munshi L, Del Sorbo L, Detsky M, Fan E. Mechanical ventilation during extracorporeal membrane oxygenation. An international survey. Ann Am Thorac Soc. 2014;11:956–61.
Schmidt M, Pellegrino V, Combes A, Scheinkestel C, Cooper DJ, Hodgson C. Mechanical ventilation during extracorporeal membrane oxygenation. Crit Care. 2014;18:203
Schmidt M, Stewart C, Bailey M, Nieszkowska A, Kelly J, Murphy L, et al. Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome: a retrospective international multicenter study. Crit Care Med. 2015;43:654–64.
Serpa Neto A, Schmidt M, Azevedo LC, Bein T, Brochard L, Beutel G, et al. Associations between ventilator settings during extracorporeal membrane oxygenation for oxygenation for refractory hypoxemia and outcome in patiens with acute respiratory distress syndrome: a pooled individual patient data analysis: Mechanical ventilation during ECMO. Intensive Care Med. 2016;42:1672–84.
Gopinath R. Ventilatory strategies in extracorporeal membrane oxygenation. Manual of extracorporeal membrane oxygenation in the ICU. 1st ed. Jaypee Brothers Medical Publishers, New Delhi, 2013: pp. 81–3.
Aufmkolk M, Fischer R, Voggenreiter G, Kleinschmidt C, Schmit-Neuerburg KP, Obertacke U. Local effect of lung contusion on lung surfactant composition in multiple trauma patients. Crit Care Med. 1999;27:1441–6.
Marraro GA, Denaro C, Spada C, Luchetti M, Giansiracusa C. Selective medicated (saline + natural surfactant) bronchoalveolar lavage in unilateral lung contusion. A clinical randomized controlled trial. J Clin Monit Comput. 2010;24:73–81.
Tsangaris I, Galiatsou E, Kostanti E, Nakos G. The effect of exogenous surfactant in patients with lung contusions and acute lung injury. Intensive Care Med. 2007;33:851–5.
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Support by Ministry of Health of the Czech Republic MH CZ—DRO—FNOs/2013 Grant is acknowledged.
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Sklienka, P., Maca, J., Bursa, F. et al. Exogenous surfactant as a bridge to prolonged “total lung rest” in severely injured patient during extracorporeal membrane oxygenation. J Artif Organs 21, 374–377 (2018). https://doi.org/10.1007/s10047-018-1037-2
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DOI: https://doi.org/10.1007/s10047-018-1037-2