Successful use of VV ECMO in managing negative pressure pulmonary edema

Grant, Brian; Ferguson, Deangelo H.; Aziz, Jenna; Aziz, Salim

doi:10.1111/jocs.14472

Cited by 7 publications

(4 citation statements)

References 13 publications

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“…ECMO is increasingly utilized as a means to provide support for severe pulmonary and/or cardiac failure. The decision to employ ECMO in our case was based on the persistence of refractory hypoxia and a lack of significant improvement with mechanical ventilation 7 . Our experience highlights the successful application of ECMO in managing MAS of sJIA patients presenting with severe respiratory failure unresponsive to standard ventilatory measures.…”

Section: Discussionmentioning

confidence: 85%

“…The decision to employ ECMO in our case was based on the persistence of refractory hypoxia and a lack of significant improvement with mechanical ventilation. 7 Our experience highlights the successful application of ECMO in managing MAS of sJIA patients presenting with severe respiratory failure unresponsive to standard ventilatory measures. To the best of our knowledge, this is the first report documenting successful remission in ECMOtreated sJIA patients who developed acute pulmonary edema and refractory shock following TCZ infusion.…”

Section: Discussionmentioning

confidence: 87%

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Successful use of extracorporeal membrane oxygenation for life‐threatening macrophage activation syndrome after treatment with tocilizumab in an systemic juvenile idiopathic arthritis patient

Yang,

Chen,

Dai

et al. 2023

Pediatric Discovery

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Macrophage activation syndrome (MAS) is a rare, potentially life‐threatening condition in rheumatic diseases. The primary treatments consist of high‐dose corticosteroids and immunosuppressive drugs, although more recently, cytokine inhibitors like anakinra or tocilizumab (TCZ) have been reported. We present a case of a child with systemic juvenile idiopathic arthritis (sJIA). After receiving a single infusion of TCZ, the child developed progressive hypoxia and was subsequently transferred to the pediatric intensive care unit (PICU) after 4 days. An immediate postintubation chest X‐ray revealed a diffuse exudative lesion. Despite continuous efforts to provide mechanical ventilation and respiratory support, the patient's oxygen saturation continued to decline. Moreover, the patient developed hemodynamic compromise, necessitating the administration of norepinephrine. Eventually, vasopressin and dopamine were added to maintain stable hemodynamics. After an intensive but ineffective treatment, extracorporeal membrane oxygenation (ECMO) was initiated in the PICU after 16 h. The patient successfully recovered and was weaned off ECMO support after 60 h. Following discharge from the PICU, given the severe refractory clinical features, we made an attempt to readminister TCZ treatment. However, within half an hour of TCZ infusion, the patient experienced anaphylaxis characterized by palpitations and chest tightness, leading to the discontinuation of TCZ. TCZ, as a biological agent, is commonly used in the treatment of sJIA. Nonetheless, the occurrence of MAS and anaphylaxis following TCZ administration for sJIA may be more prevalent than previously recognized. Pediatric rheumatologists should exercise caution when initiating TCZ for active sJIA. Furthermore, we want to underscore the importance of life‐saving techniques such as ECMO for sJIA patients in emergency situations.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 87%

Successful use of extracorporeal membrane oxygenation for life‐threatening macrophage activation syndrome after treatment with tocilizumab in an systemic juvenile idiopathic arthritis patient

Yang,

Chen,

Dai

et al. 2023

Pediatric Discovery

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“…In the treatment of NPPE, sufficient oxygenation or noninvasive positive pressure ventilation is effective, and reintubation is sometimes necessary in severe cases; however, cases requiring extracorporeal membrane oxygenation have rarely been reported [14][15][16]. The cause of postoperative pulmonary edema is either cardiogenic or noncardiogenic [17].…”

Section: Discussionmentioning

confidence: 99%

Extraordinary Delayed-Onset Negative Pressure Pulmonary Hemorrhage Resulting in Cardiac Arrest after General Anesthesia for Vocal Cord Polypectomy

Koide¹,

Kitada²,

Kogure³

et al. 2020

Case Reports in Critical Care

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Negative pressure pulmonary edema and hemorrhage are uncommon but potentially life-threatening complications associated with general anesthesia. Postoperative negative pressure pulmonary edema usually occurs immediately after surgery, and delayed-onset cases occurring more than 1 hour after surgery have rarely been reported. A 37-year-old woman with bronchial asthma underwent vocal cord polypectomy under general anesthesia in another hospital and experienced cardiac arrest due to a negative pressure pulmonary hemorrhage occurring 3 hours and 30 minutes after surgery. She was successfully treated with venoarterial extracorporeal membrane oxygenation and completely recovered without any complications. Extraordinary delayed-onset negative pressure pulmonary hemorrhage occurring more than three hours after surgery has rarely been reported. This case may indicate the need for more careful observation of patients following surgery.

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“…As aforementioned, patients who have developed upper airway obstruction or have predisposing factors, but have not yet exhibited pulmonary edema, require close observation in the post-anesthesia care unit, although the duration of observation remains controversial ( 1 ). Previously, Grant et al ( 60 ) reported the case of a 26-year-old female patient with laryngeal papillomatosis who developed laryngospasm after direct laryngoscopy. The patient developed severe NPPE, for which mechanical ventilator support was ineffective.…”

Section: Treatmentsmentioning

confidence: 99%

Negative pressure pulmonary edema (Review)

Liu

Wang

et al. 2023

Exp Ther Med

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Negative pressure pulmonary edema (NPPE) is a complication resulting from acute or chronic upper airway obstruction, often posing challenges in recognition and diagnosis for clinicians. If left untreated, NPPE can lead to hypoxemia, heart failure and even shock. Furthermore, the drug treatment of NPPE remains a subject of controversy. The primary pathophysiological mechanism of NPPE involves the need for high inspiratory pressure to counteract upper airway obstruction, subsequently causing a progressive rise in negative pressure within the pleural cavity. Consequently, this results in increased pulmonary microvascular pressure, leading to the infiltration of pulmonary capillary fluid into the alveoli. NPPE exhibits numerous risk factors and causes, with laryngospasm following anesthesia and extubation being the most prevalent. The diagnosis of NPPE often presents challenges due to confusion with conditions such as gastroesophageal reflux or cardiogenic pulmonary edema, given the similarity in initial factors triggering both diseases. Upper airway patency, positive pressure non-invasive ventilation, supplemental oxygen and re-intubation mechanical ventilation are the foundation of the treatment of NPPE. The present review aims to discuss the etiology, clinical presentation, pathophysiology and management of NPPE.

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Successful use of VV ECMO in managing negative pressure pulmonary edema

Cited by 7 publications

References 13 publications

Successful use of extracorporeal membrane oxygenation for life‐threatening macrophage activation syndrome after treatment with tocilizumab in an systemic juvenile idiopathic arthritis patient

Successful use of extracorporeal membrane oxygenation for life‐threatening macrophage activation syndrome after treatment with tocilizumab in an systemic juvenile idiopathic arthritis patient

Extraordinary Delayed-Onset Negative Pressure Pulmonary Hemorrhage Resulting in Cardiac Arrest after General Anesthesia for Vocal Cord Polypectomy

Negative pressure pulmonary edema (Review)

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