Catastrophic respiratory failure from tuberculosis pneumonia: Survival after prolonged extracorporeal membrane oxygenation support

Abstract

Tuberculosis (TB) is an uncommon cause of severe respiratory failure, even in highly endemic regions. Mortality in cases requiring mechanical ventilation (MV) varies between 60 and 90%. The use of extracorporeal membrane oxygenation (ECMO) is not frequently needed in TB. We report the case of a 24 year old woman diagnosed with bilateral pneumonia that required MV and intensive care, patient was managed with prone ventilation for 48 h, but persisted in refractory hypoxemia. Etiological study was only positive for mycobacterium tuberculosis. As a rescue therapy arterio-venous extracorporeal CO2 removal was started and lased for 4 days, but fails to support the patient due to greater impairment of oxygenation. Veno-venous ECMO was then initiated, thus normalizes gas exchanged and allows lungs to rest. ECMO was maintained for 36 days, with two episodes of serious complication treated successfully. Given the absence of clinical improvement and the lack of nosocomial infection, at 42-day of ICU stay methylprednisolone 250 mg daily for 4 days was started, since secondary organizing pneumonia associated with TB was suspected. Thereafter progressive improvement in pulmonary mechanics and reduction of pulmonary opacities was observed, allowing the final withdrawal of ECMO. Percutaneous tracheostomy was performed and the patient remained connected until her transfer to her base hospital at day 59 of admission to our unit. The tracheostomy was removed prior to hospital discharge, and the patient is today at home. Prolonged ECMO support is a useful and potentially successful tool in catastrophic respiratory failure caused by TB.

Acute respiratory distress syndrome due to severe pulmonary tuberculosis treated with extracorporeal membrane oxygenation: A case report and review of the literature

“…Andresen et al. similarly reported that systemic corticosteroid therapy during ECMO support led to progressive improvement of respiratory function [14] . Several other studies have also suggested the effectiveness of adjunctive use of corticosteroids for PTB [19] , [20] , [21] .…”

“…The mortality of ARDS patients with PTB requiring MV is relatively high compared with that of patients with ARDS from other causes [9] . Five patients with acute respiratory failure due to PTB were recently reported to be successfully rescued by ECMO [10] , [11] , [12] , [13] , [14] , [15] ( Table 1 ). Given the high mortality rate of ARDS patients with PTB, ECMO could be an important treatment option.…”

Use of extracorporeal membrane oxygenation in an awake patient after a major trauma with an incidental finding of tuberculosis

“…Perfusion 31 (4) After cannulation, the invasiveness of the mechanical ventilation was reduced to facilitate lung healing. Tidal volume (4 ml/kg ideal body weight), positive endinspiratory pressure (less than 28 mmHg) and FiO 2 were decreased.…”

“…2 The treatment of TB patients with ECMO has been described, although TB-induced severe lung failure is rare. 3,4 Less than 5% of TB patients require mechanical support. 5 Extracorporeal lung support provides time for lung recovery when it is administered in combination with adequate therapy for the underlying disease.…”

Idiopathic pulmonary fibrosis patient supported with extracorporeal membrane oxygenation for 403 days while waiting for a lung transplant: A case report

“…According to the 2016 Extracorporeal Life Support Organization (ELSO) registry report, the average duration of V-V ECMO in adults with acute respiratory failure is 10.5–13.5 days [ 1 ]. Some patients whose lung damage is not improved may require support of V-V ECMO for more than 2 weeks, and recently, there have been more reports of prolonged V-V ECMO [ [2] , [3] , [4] , [5] , [6] , [7] , [8] ]. However, we do not know how long it is feasible to wait for native lung recovery or lung transplant (LTx) with the use of ECMO.…”