Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a life-saving treatment for respiratory failure that may serve as a bridge to patient recovery or lung transplantation. In COVID-19, recovery is somewhat unpredictable and occasionally occurs after >100 days on VV-ECMO support. Thus, determining therapy cessation may be difficult. We report the case of a 59-year-old male without specific risk factors admitted to a tertiary center for rapidly progressive respiratory failure due to severe COVID-19, despite aggressive mechanical ventilatory support. Immediate insertion of VV-ECMO was associated with prompt resolution of hypoxemia and hypercapnia; however, all therapeutic efforts to wean the patient from VV-ECMO failed. During the prolonged hospitalization on VV-ECMO, sepsis was the most life-threatening complication. The patient overcame roughly 40 superinfections, predominantly affecting the respiratory tract, and spent 183 days on antimicrobial treatment. Although the function of other organ systems was generally stable, gradually progressive right ventricular dysfunction due to precapillary pulmonary hypertension required increasing doses of inotropes. A successful lung transplantation was performed after 207 days of VV-ECMO support. The present case provides evidence for prolonged VV-ECMO therapy as a bridge to lung transplantation in severe COVID-19 despite numerous, predominantly infectious complications.
The nosocomial infection was determinate as the direct cause of the dead in 49 (38.5%) patients. The highest mortality rate belonged to the PICU with 83.3% (10/12), follow by the NICU 71.4% (15/21); the mortality rate in the Newborn Unit was 70.5% (12/17); in contrast in the Surgery department the mortality rate was 0. In 65 of the cases at least one microorganism was isolated, being K. pneumonia Extended Spectrum Beta Lactamases (ESBLs), the most frequently isolated, 21.5% (14/65), it was also responsible of mostly of the mortal cases, and by area the most isolated from the NICU. No MRSA was isolated in this revision.
Conclusion:Although the creation of the Nosocomial Infections Surveillances Committee, the nosocomial infections, its burden in costs, morbidity and mortality continuing being a big concern, especially in the NICU and Newborn Unit. Moreover, the high costs of the treatment for those kinds of infections sometimes are not affordable for patients in a weak healthcare system.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.