Abstract:Extracorporeal membrane oxygenation (ECMO) is used as a salvage therapy in refractory acute respiratory distress syndrome (ARDS). Although technological progress in the ECMO systems improved the survival rate, prognosis is still significantly worsened by acute kidney injury (AKI), particularly if renal replacement therapy (RRT) is required. There are no exact guidelines recommending which techniques of ECMO and continuous RRT (CRRT) should be used for management of AKI coexisting with respiratory or circulatory failure, and how to combine them. The aim of this review is to describe methods of CRRT and ECMO simultaneous application, and to present advantages of various technical approaches versus possible complications.
Background. Plasmapheresis is one of the methods of extracorporeal blood purification involving the removal of inflammatory mediators and antibodies. The procedure is used in a variety of ailments, including autoimmune diseases. The aim of the present study was to analyse the incidence of plasmapheresis-related complications in patients treated in the intensive care unit (ICU). Methods. The analysis involved 370 plasmapheresis procedures in 54 patients. The data were collected from patients` medical records, including procedure protocols. Results. The most common diseases treated with plasmapheresis included: myasthenia gravis (33.3%), Guillain-Barré syndrome (14%), Lyell's syndrome (9.3%), systemic lupus erythematosus (7.4%), and thrombotic thromcytopenic purpura (7.4%). The adverse side effects observed most frequently during plasma filtration were decreases in arterial blood pressure (8.4% of all procedures), arrhythmias (3.5%), sensations of cold with temporarily elevated temperature and paresthesias (1.1%, each). In most cases, the symptoms were mild and transient. Severe and life-threatening episodes, i.e. shock, drops in arterial blood pressure requiring catecholamines administration, persistent arrhythmias and haemolysis, developed in 2.16% of procedures. Conclusions. Plasmapheresis can be considered a relatively safe method of treatment of ICU patients. Continuous observation and proper monitoring of patients provided by highly trained medical personnel are essential for its safety.
Toxic epidermal necrolysis (TEN) is a rare, life-threatening disease with a high mortality rate. It is linked to drug toxicity and characterized by epidermal necrolysis with mucositis and conjunctivitis. Treatment is not established due to the unknown pathogenesis and lack of randomized clinical trials. It is mostly based on withdrawal of the culprit drug and symptom-related approach. The role of corticosteroids and plasmapheresis in the disease treatment remains controversial. We present two patients with severe TEN (both with >80% body skin surface involvement) treated unsuccessfully with corticosteroids followed by plasmapheresis. Plasmapheresis led to prompt improvement, with extensive reepithealization of the skin, and eventually total recovery of both patients. In severe TEN unresponsive to corticosteroids, treatment with plasmapheresis should be considered.
Acute respiratory failure is one of the most frequent reasons for hospitalization in intensive care units (ICU) [1]. Dyspnea, reflected by hypoxemia and in some cases also by hypercapnia and respiratory acidosis in blood gas analysis, dominates in the clinical presentation. A disproportion between alveolar ventilation and pulmonary blood flow is usually the reason for hypoxemia and less often gas diffusion impairment across the air-blood barrier. The main mechanism of hypercapnia is alveolar hypoventilation which may be of neurological origin. The most frequent disorders associated with the peripheral nervous system are myasthenic crisis and acute polyneuropathies, especially acute inflammatory polyradiculoneuropathy, known as Guillain-Barré syndrome (GBS). It may lead to respiratory muscle paralysis, while in myasthenia muscle fatigue increases gradually. As a result of hypoventilation atelectasis occurs, and impairment of swallowing and cough reflexe predisposes to pneumonia which aggravates the respiratory failure. In such an event an immediate initiation of respiratory failure treatment in the ICU and the most rapid causative management are crucial [1]. Plasmapheresis (plasma exchange) is the management of choice in acute respiratory failure associated with GBS and myasthenic crisis [2,3]. The
A 33-year-old woman in the 28th week of gestation was admitted to the Gynecology and Obstetrics Department of our hospital with a diagnosis of H1N1 influenza and bilateral pneumonia. She developed acute respiratory failure requiring intubation and mechanical ventilation followed by rescue cesarean delivery and transfer to our Department. Wide-spectrum antimicrobial treatment with oseltamivir and positive end-expiratory pressure (PEEP) of up to 15 cm H 2 O led to temporary improvement, but after 9 days, the ratio of arterial blood oxygen partial pressure (PaO 2 ) to fraction of inspired oxygen (FiO 2 ) dropped below 80 mmHg, indicating severe acute respiratory distress syndrome (ARDS) according to the Berlin definition. 1 Chest X-rays showed extensive bilateral pulmonary consolidations (FIGURE 1A). Despite modifications of ventilator settings and recruitment maneuvers, pulmonary compliance and arterial blood oxygenation
CLINICAL IMAGEPregnancy-related H1N1 influenza and severe acute respiratory distress syndrome successfully treated with extracorporeal membrane oxygenation despite difficult vascular access
L yell disease, commonly referred to as toxic epidermal necrolysis (TEN), is a rare, lifethreatening condition probably related to drug hypersensitivity; the mortality rate is approximately 30%.1 The disease is characterized by an initial pruritic, erythematous rash followed by the appearance of bullae, which subsequently lead to ulceration and sloughing of the underlying epidermal base similar to physiological damages caused by burns. Moreover, TEN causes crusting, desquamation, and ulceration of the mucous membranes in areas such as the oral, ocular, and genital mucosa.2 Bleeding from internal mucous membranes, especially those in the gastrointestinal and respiratory tracts, can progress to hypovolemia and lead to death. TEN is often accompanied by ocular manifestations ranging from acute conjunctivitis to corneal abrasion and, in the most severe cases, corneal ulceration.3 These changes can lead to permanent loss of vision. Feature A patient with severe toxic epidermal necrolysis underwent 2 cycles of therapeutic plasma exchange and received specialized wound care for widespread skin damage of more than 80% of his body surface area. Extensive involvement of mucous membranes, including the conjunctivas and the oropharyngeal cavity, and damage of his genitourinary organs required meticulous wound care. Daily care of injuries of tissues affected only in the most severe cases of toxic epidermal necrolysis was provided by an experienced intensive care unit nursing team. A meticulous supportive therapy regimen was a major contributing factor to this patient's remission.
Supportive Therapy(Critical Care Nurse.
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.