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Anand S, Singla R, Kumar V, Dewan S, Faye A, Gupta A. A new role of extracorporeal membrane oxygenation in the management of tuberculosis with acute respiratory distress syndrome: A case report and review of literature. Lung India 2022; 39:77-79. [PMID: 34975058 PMCID: PMC8926221 DOI: 10.4103/lungindia.lungindia_173_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Pulmonary tuberculosis (PTB) can lead to acute respiratory distress syndrome (ARDS), which can be at times fatal. Venovenous extracorporeal membrane oxygenation (VV-ECMO) ensures adequate oxygenation and carbon dioxide removal, avoiding ventilator-induced lung injury. We present a case where a young woman with refractory respiratory failure caused by PTB, unresponsive to conventional mechanical ventilation, but was successfully managed with prolonged VV-ECMO support. The patient diagnosed with PTB was started on antitubercular treatment but went into respiratory failure and ARDS. The patient was put on mechanical ventilation, on which she was not improving. The patient was then put on ECMO. On the 9th day, lung compliance and gas exchange were good enough to resume conventional mechanical ventilation. ECMO was weaned and removed. This is one of few cases of survival of the patient with PTB with ARDS utilizing ECMO.
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Affiliation(s)
- Shweta Anand
- Department of Tuberculosis and Chest Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Rupak Singla
- Department of Tuberculosis and Chest Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Vikas Kumar
- Department of Tuberculosis and Chest Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Sandeep Dewan
- Department of Critical Care Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Abhishek Faye
- Department of Tuberculosis and Chest Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Amitesh Gupta
- Department of Tuberculosis and Chest Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
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Besa S, Morales ÁJ, Salas P, Bravo M S, Garrido-Olivares L. Extracorporeal membrane oxygenation for tuberculosis pneumonia with empyema. Respir Med Case Rep 2021; 34:101481. [PMID: 34341715 PMCID: PMC8313788 DOI: 10.1016/j.rmcr.2021.101481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/30/2021] [Accepted: 07/23/2021] [Indexed: 12/04/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) caused by Mycobacterium Tuberculosis (TB) is a rare entity. Extracorporeal membrane oxygenation (ECMO) therapy had been used as an effective therapy for this cases, but the evidence is scarce. We present a case that took place in the middle of SARS-CoV2 pandemic. A 33-year-old female presented with ARDS due to pulmonary TB infection (pneumonia with empyema and pneumothorax), which required invasive mechanical ventilation with poor response. Long term veno-arterio-venous (VAV) ECMO, overlapped with veno-venous ECMO, was used as a salvage therapy with a good response for a total of 26 days. This is an example of the effectiveness of this therapy in this scenario, never described before. The fact that this therapy was used in the middle of SARS-CoV2 pandemic, with limited resources available, was remarkable, but it was encouraged by previous successful experiences.
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Affiliation(s)
- Santiago Besa
- Department of Cardiovascular Surgery, Division of Surgery, Pontificia Universidad Católica, Santiago, Chile
| | - Álvaro J Morales
- Medical School, Pontificia Universidad Católica, Santiago, Chile
| | - Patricio Salas
- Department of Thoracic Surgery, Division of Surgery, Pontificia Universidad Católica, Santiago, Chile
| | - Sebastián Bravo M
- Department of Intensive Medicine, Division of Internal Medicine, Pontificia Universidad Católica, Santiago, Chile
| | - Luis Garrido-Olivares
- Department of Cardiovascular Surgery, Division of Surgery, Pontificia Universidad Católica, Santiago, Chile
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Pneumonia caused by Mycobacterium tuberculosis. Microbes Infect 2020; 22:278-284. [PMID: 32561408 PMCID: PMC7297158 DOI: 10.1016/j.micinf.2020.05.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 12/17/2022]
Abstract
Tuberculosis (TB) is one of the top ten leading causes of death worldwide. The causative agent of TB is Mycobacterium tuberculosis. Acute tuberculous pneumonia (TP) is an acute form of pulmonary TB. However, acute TP and non-tuberculous community-acquired pneumonia can be easily confused, resulting in deterioration of TP due to delayed treatment. Therefore, rapid and accurate diagnosis of acute TP is crucial in order to stop the transmission of TB. Moreover, development of new diagnostic tools (technologies and approaches), and flexible application of different therapy schemes will help to reduce the incidence of TP and promote the goal of ending the TB epidemic.
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An interesting case summary of tubercular pneumonia masquerading as viral pneumonia kept on extra-corporeal membrane oxygenation. Indian J Tuberc 2019; 67:268-273. [PMID: 32553326 DOI: 10.1016/j.ijtb.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/02/2019] [Indexed: 11/24/2022]
Abstract
Mortality in patients with pulmonary tuberculosis remains high, especially in those who develop acute respiratory distress syndrome (ARDS). We herein, report a case of 40 year old female, with ARDS due to severe pulmonary tuberculosis. She was admitted in the intensive care unit of a tertiary care centre. Owing to very poor ABG report, she was intubated and put on Mechanical ventilator support. Bronchoscopy was performed and BAL was extracted, which showed no growth. Further deterioration of gas exchange prompted the decision to put her on ECMO. During her stay on ECMO, she developed massive inta-alveolar hemorrhage following which repeated bronchoscopic interventions were done to remove blood clots. BAL extracted on day 4 and day 8 showed growth of A. baumannii and K. pneumoniae respectively. But BALGeneXpert on day 8 came out to be positive for Mycobacterium Tuberculosis and subsequently ATT was added to her treatment regimen. Her alveolar hemorrhage continued to worsen and subsequently ECMO was removed. After 12 days of hospitalization, she went on to develop bradycardia and could not be rescued. Though the patient's life was lost, this case provided many insights on the use of ECMO in the management of ARDS due to Pulmonary tuberculosis and it should be considered as one of the treatment options.
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Veno–veno–arterial extracorporeal membrane oxygenation for acute respiratory distress syndrome with septic-induced cardiomyopathy due to severe pulmonary tuberculosis. J Artif Organs 2017; 20:359-364. [DOI: 10.1007/s10047-017-0982-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 08/24/2017] [Indexed: 01/21/2023]
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Omote N, Kondoh Y, Taniguchi H, Kimura T, Kataoka K, Hasegawa R, Hasegawa Y. Acute respiratory distress syndrome due to severe pulmonary tuberculosis treated with extracorporeal membrane oxygenation: A case report and review of the literature. Respir Med Case Rep 2016; 19:31-3. [PMID: 27408786 PMCID: PMC4927661 DOI: 10.1016/j.rmcr.2016.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/04/2016] [Accepted: 06/08/2016] [Indexed: 12/05/2022] Open
Abstract
Mortality in patients with pulmonary tuberculosis remains high, especially in those who develop acute respiratory distress syndrome (ARDS). We report on a-48-year-old man with ARDS due to severe pulmonary tuberculosis who was rescued by extracorporeal membrane oxygenation (ECMO). He was initially hospitalized in the intensive care unit and noninvasive positive-pressure ventilation started. He was also administered anti-tuberculosis drugs and received systemic corticosteroid therapy. Six days later, further deterioration of gas exchange prompted the decision to intubate. However, he experienced progressive deterioration of arterial oxygenation despite conventional ventilatory support. We therefore decided to administer ECMO on day 9. After initiation of these treatments and ECMO support, pulmonary infiltrate and oxygenation status gradually improved and ECMO was discontinued on day 52. The patient was finally discharged from our hospital without severe disability. ECMO should be considered one of the treatment options for the management of ARDS due to severe pulmonary tuberculosis.
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Affiliation(s)
- Norihito Omote
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
- Corresponding author. Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi 489-8642, Japan.Department of Respiratory Medicine and AllergyTosei General Hospital160 Nishioiwake-choSetoAichi489-8642Japan
| | - Hiroyuki Taniguchi
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Tomoki Kimura
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Kensuke Kataoka
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Ryuichi Hasegawa
- Department of Emergency and Intensive Care Medicine, Intensive Care Unit, Tosei General Hospital, Seto, Aichi, Japan
- Department of Emergency and Critical Care Medicine, Mito Clinical Education and Training Center, Tsukuba University Hospital, Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan
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Nam SJ, Cho YJ. The successful treatment of refractory respiratory failure due to miliary tuberculosis: survival after prolonged extracorporeal membrane oxygenation support. THE CLINICAL RESPIRATORY JOURNAL 2016; 10:393-9. [PMID: 26683127 DOI: 10.1111/crj.12437] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 12/04/2015] [Accepted: 12/14/2015] [Indexed: 02/05/2023]
Abstract
Acute respiratory distress syndrome (ARDS) has high morbidity and mortality. Although uncommon, pulmonary tuberculosis (TB) can cause ARDS in patients with extensive pulmonary parenchymal involvement. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an accepted alternative option in refractory hypoxemic respiratory failure. It may normalize gas exchange and allow lung rest, avoiding ventilator induced lung injury. We report the case of a 44-year-old woman who developed ARDS secondary to pulmonary TB. Despite anti-TB treatment and mechanical ventilation, patient had persistent refractory hypoxemia. In order to prevent further lung injury, VV-ECMO support was performed for 73 days. Although the patient experienced several complications, patient was successfully managed on VV-ECMO. VV-ECMO support, in combination with anti-TB drugs, is a useful tool in the treatment of ARDS with refractory hypoxemia caused by miliary TB.
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Affiliation(s)
- Sung-Jin Nam
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Haneke F, Schildhauer TA, Strauch J, Swol J. Use of extracorporeal membrane oxygenation in an awake patient after a major trauma with an incidental finding of tuberculosis. Perfusion 2015; 31:347-8. [PMID: 26498750 DOI: 10.1177/0267659115615208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report the use of extracorporeal membrane oxygenation (ECMO) in a trauma patient with an incidental finding of open tuberculosis (TB). Sedation was reduced during extracorporeal support and awake veno-venous ECMO was successfully performed. Subsequently, accidental cannula removal caused major blood loss which required the administration of cardiopulmonary resuscitation (CPR). Our case report demonstrates that the incidental finding of open TB is an important hint for differential diagnosis and that it should still be considered in high-income countries. In addition, awake ECMO appears to be a feasible therapeutic option in non-transplant patients, although the described case demonstrates that patient compliance and nursing care are important for therapeutic success to avoid complications, for example, inadvertent decannulation.
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Affiliation(s)
- F Haneke
- Department of General Surgery and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - T A Schildhauer
- Department of General Surgery and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - J Strauch
- Department of Cardiac and Thoracic Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - J Swol
- Department of General Surgery and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
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Mendes MDS, Yeh-Li H, Romano TG, Santos EV, Hirota AS, Kono BM, Felicio MF, Park M. Varicella associated acute respiratory distress syndrome in an adult patient: an example for extracorporeal respiratory support in Brazilian endemic diseases. Rev Bras Ter Intensiva 2015; 26:410-5. [PMID: 25607272 PMCID: PMC4304471 DOI: 10.5935/0103-507x.20140063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 10/10/2014] [Indexed: 12/12/2022] Open
Abstract
A case of a 30 year-old man presenting with severe systemic chickenpox with
refractory hypoxemia, central nervous system vasculitis and anuric renal failure is
described. Ambulance transportation and support using veno-venous extracorporeal
membrane oxygenation were necessary until the patient recovered. Ultimately, the
potential use of extracorporeal membrane oxygenation support in low-middle income
countries to manage common diseases is discussed.
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Affiliation(s)
- Marcela da Silva Mendes
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ho Yeh-Li
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Thiago Gomes Romano
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Adriana Sayuri Hirota
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Bruna Mitiyo Kono
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Marcelo Park
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Frick SE, Flothmann C, Preiswerk B, Behr R, Genoni M. Extracorporeal Membrane Oxygenation in Miliary Tuberculosis and AIDS: A Case Report. Thorac Cardiovasc Surg Rep 2014; 4:18-20. [PMID: 26693121 PMCID: PMC4670299 DOI: 10.1055/s-0034-1394105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 08/05/2014] [Indexed: 11/20/2022] Open
Abstract
Background The aim of this study is to present the success of a multidisciplinary approach in a patient with a rare triad of disease. Case Description A 33-year-old patient with newly diagnosed human immunodeficiency virus infection presented with miliary tuberculosis, consecutive adult respiratory distress syndrome, and multiple-organ failure. An interdisciplinary, time-limited approach combining extracorporeal membrane oxygenation, intensive care therapy, hemodiafiltration, tuberculostatic therapy, steroids, and antiretroviral therapy led to survival despite a low probability at presentation. Conclusion Even though the use of such extensive and expensive treatment can be questioned, this example encourages an aggressive approach in a young patient, even in situations of multiple diagnosis of individually limited prognosis.
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Affiliation(s)
| | | | - Benjamin Preiswerk
- Internal Medicine, Infectious Diseases, Stadtspital Triemli, Zürich, Switzerland
| | - Renate Behr
- Department of Cardiovascular Surgery, Stadtspital Triemli, Zürich, Switzerland
| | - Michele Genoni
- Department of Cardiovascular Surgery, Stadtspital Triemli, Zürich, Switzerland
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Andresen M, Tapia P, Mercado M, Bugedo G, Bravo S, Regueira T. Catastrophic respiratory failure from tuberculosis pneumonia: Survival after prolonged extracorporeal membrane oxygenation support. Respir Med Case Rep 2013; 10:19-22. [PMID: 26029505 PMCID: PMC3920359 DOI: 10.1016/j.rmcr.2013.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 05/28/2013] [Accepted: 06/03/2013] [Indexed: 01/09/2023] Open
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.
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Macintosh I, Butt WW, Robertson CF, Best D, Shekerdemian LS. Extending the limits of extracorporeal membrane oxygenation: lung rest for a child with non-specific interstitial pneumonia. Intensive Care Med 2005; 31:993-6. [PMID: 15803293 DOI: 10.1007/s00134-005-2620-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Accepted: 03/04/2005] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Veno-venous extracorporeal membrane oxygenation (ECMO) is an established therapy for the treatment of respiratory failure. Traditionally ECMO has been used to support patients with an acute, reversible disease process, with a predictable outcome. We report the successful use of veno-venous ECMO for an unusual indication. PATIENT A 10-year old girl was admitted to intensive care with severe, hypoxic respiratory failure on the background of a 2-month history of worsening respiratory symptoms. She required high levels of conventional positive pressure ventilation, and high frequency oscillation. Lung biopsy confirmed a non-specific interstitial pneumonia, and the patient was commenced on immune suppressive therapy. Her clinical course was further complicated by pulmonary haemorrhage and severe air leak. INTERVENTIONS On day 20 after admission the patient was placed on veno-venous ECMO for lung rest while awaiting a response to continued medical treatment. She required ECMO for 20 days, during which time sedation was reduced, and she was able to interact with those around her. The patient's ventilatory requirements after decannulation were minimal, and she subsequently made a steady clinical recovery. CONCLUSIONS ECMO was safely and successfully used to provide a period of lung rest and time for medical therapy to take effect in a child with an unusual indication for support: a rare disease with an uncertain outcome on the background of prolonged mechanical ventilation.
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Affiliation(s)
- Iain Macintosh
- Department of Paediatric Intensive Care, The Royal Children's Hospital, Flemington Road, 3052, Parkville, VIC, Australia
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