Background: Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) is one effective treatment for COVID-19 pneumonia, but controversy regarding VV-ECMO management in obese patients still exists. In this report, we described a case in which two oxygenators were used in parallel in a severely obese patient (Body mass index: 60 kg/m2, body surface area: 2.8 m2). Case: The case was of a 27-year-old man diagnosed with COVID-19 pneumonia and admitted to our hospital. VV-ECMO was required on the fifth day after admission due to gradually worsening respiratory conditions and partial pressure of arterial oxygen (PaO2)/FiO2 ratio of 77. Immediately after the initiation of VV-ECMO, post-oxygenator in circuit, PaO2 was low at 134 mmHg. Even though the VV-ECMO circuit was replaced on the same day, the PaO2 still was low at 261 mmHg. Thus, we decided to use two oxygenators in parallel, after which the PaO2 stabilized at 400–500 mmHg.Conclusions: In this case, VV-ECMO oxygenation could be stabilized by utilizing two oxygenators in parallel. Using two membrane oxygenators may be a treatment option in severely obese patients with respiratory failure.
We report a case of COVID‐19‐induced extracorporeal membrane oxygenation treated by late i.v. steroid administration. Our case suggests the value of prospective clinical trials for the evaluation of steroid use in severe COVID‐19‐induced extracorporeal membrane oxygenation.
Introduction
Patients with combined burn and trauma are common in the United States and combined trauma in the burn increase the mortality. On contrast, their characteristics and outcomes remain unknown in Japan. The aim of present study was to elucidate the characteristics of trauma combined burn in Japan.
Methods
A multicenter retrospective study was performed between 2004 and 2017 using data from the Japan Trauma Data Bank (JTDB). We evaluated characteristics in burn patients (n=5,783) by segregating them into two groups cohorts: burn only (n=5,537) and combined burn and trauma(n=246). Clinical characteristics such as patient background, severity of burn and trauma, mechanism of injuries, total body surface area (TBSA), injury lesion, treatment and outcome were examined.
Results
The results showed significant differences in age between the burn only group and combined burn and trauma group (median [IQR]: 61 [43–76] for burn only group vs 51 [39–66] for combined burn and trauma group, p < 0.001). Most patients were injured due to flame (burn only group, 65.7%; combined burn and trauma group, 54.9%). Furthermore, 40-89% TBSA was higher in burn only group (19.3%) than in the combined burn and trauma group (9.3%). In-hospital mortality in burn only group (18.2%) was higher than that in the combined burn and trauma group (6.9%).
Conclusions
We demonstrated that the characteristics of burn only and combined burn and trauma patients in Japan. Flame was main cause of burn and in-hospital mortality was higher in burn only group because of higher burn area.
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