Mechanical Circulatory Support in Patient with Pulmonary Dysfunction
In this chapter we report the case of a 51-year-old male, without comorbidities, with a history of infection of the lower airways with evolution to severe acute respiratory syndrome and acquired pneumonia with an etiological diagnosis of H1N1 infection. After the diagnosis, the patient was in refractory hypoxemia despite the mechanical ventilation with SaO2 80% and FiO2 100%, using a low dose of norepinephrine and presenting asynchronous breathing. The patient’s hypoxemia worsened, also developing a pulmonary dysfunction with high ventilatory parameters installed besides taking methylprednisolone. Thus, doctors decided to install ECMO veno-venosa (extracorporeal membrane oxygenation) in order to maintain tissue oxygenation, while the lungs were pulped for better recovery of lung function. Soon after the installation of the support, the ventilatory and laboratory parameters improved. There were several attempts to wean VV-ECMO after the sixth day undergoing circulatory support, but the patient was not responding satisfactorily. During this period, five hemorrhagic events occurred, at the drain and venipuncture sites. A few days later, there was no response to nociceptive stimuli, with mydriatic pupils and corneal reflex absent bilaterally; Glasgow 3 and the CT scan showed right massive temporal-parietal bleeding associated with hemoventricle; Duret hemorrhage, diffuse brain swelling, and a great deviation from the midline structures were noted. There was no indication of surgical treatment; the protocol of brain death was started, with confirmation of brain death by cerebral arteriography. After reporting the evolution of the patient during his ICU stay, we also discussed some points about ECMO, such as its indications, advantages, and disadvantages, among others.
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