Extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome in severe malaria

Carlos Alves, Jen-Ting (Tina) Chen, Nina Patel, Darryl Abrams, Paulo Figueiredo, Lurdes Santos, António Sarmento, José Artur Paiva, Matthew Bacchetta, May Lin Wilgus, Roberto Roncon-Albuquerque, Daniel Brodie

Research output: Contribution to journalArticle

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Abstract

Background: Severe malaria may be complicated by the acute respiratory distress syndrome (ARDS), which is associated with a high mortality. In the present report, a series of three cases of imported malaria complicated by refractory severe ARDS supported with extracorporeal membrane oxygenation (ECMO) is presented. Methods. One female and two male adult patients (ages 39 to 53) were included. Two patients had Plasmodium falciparum infection and one patient had Plasmodium vivax and Plasmodium ovale co-infection. Anti-malarial therapy consisted in intravenous quinine (in two patients) and intravenous quinidine (in one patient), plus clindamycin or doxycycline. Results: Despite lung protective ventilation, a conservative strategy of fluid management, corticosteroids (two patients), prone position (two patients) and inhaled nitric oxide (one patient), refractory severe ARDS supervened (PaO§ssub§2§esub§ to FiO§ssub§2§esub§ ratio 68) and venovenous ECMO was then initiated. In one patient, a bicaval dual-lumen cannula was inserted; in the two other patients, a two-site configuration was used. Two patients survived to hospital-discharge (duration of ECMO support: 8.5 days) and one patient died from nosocomial sepsis and multi-organ failure after 40 days of ECMO support. Conclusions: ECMO support allowed adequate oxygenation and correction of hypercapnia under lung protective ventilation, therefore reducing ventilator-induced lung injury. ECMO referral should be considered early in malaria complicated by severe ARDS refractory to conventional treatment.

Original languageEnglish (US)
Article number306
JournalMalaria Journal
Volume12
Issue number1
DOIs
StatePublished - 2013
Externally publishedYes

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Extracorporeal Membrane Oxygenation
Adult Respiratory Distress Syndrome
Malaria
Severe Acute Respiratory Syndrome
Ventilation
Plasmodium ovale
Ventilator-Induced Lung Injury
Plasmodium vivax
Prone Position
Lung
Quinidine
Quinine
Clindamycin
Hypercapnia
Doxycycline
Antimalarials
Plasmodium falciparum
Coinfection
Sepsis
Adrenal Cortex Hormones

Keywords

  • Acute respiratory distress syndrome
  • Extracorporeal membrane oxygenation
  • Malaria
  • Plasmodium falciparum

ASJC Scopus subject areas

  • Infectious Diseases
  • Parasitology
  • Medicine(all)

Cite this

Extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome in severe malaria. / Alves, Carlos; Chen, Jen-Ting (Tina); Patel, Nina; Abrams, Darryl; Figueiredo, Paulo; Santos, Lurdes; Sarmento, António; Paiva, José Artur; Bacchetta, Matthew; Wilgus, May Lin; Roncon-Albuquerque, Roberto; Brodie, Daniel.

In: Malaria Journal, Vol. 12, No. 1, 306, 2013.

Research output: Contribution to journalArticle

Alves, C, Chen, J-TT, Patel, N, Abrams, D, Figueiredo, P, Santos, L, Sarmento, A, Paiva, JA, Bacchetta, M, Wilgus, ML, Roncon-Albuquerque, R & Brodie, D 2013, 'Extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome in severe malaria', Malaria Journal, vol. 12, no. 1, 306. https://doi.org/10.1186/1475-2875-12-306
Alves, Carlos ; Chen, Jen-Ting (Tina) ; Patel, Nina ; Abrams, Darryl ; Figueiredo, Paulo ; Santos, Lurdes ; Sarmento, António ; Paiva, José Artur ; Bacchetta, Matthew ; Wilgus, May Lin ; Roncon-Albuquerque, Roberto ; Brodie, Daniel. / Extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome in severe malaria. In: Malaria Journal. 2013 ; Vol. 12, No. 1.
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AU - Abrams, Darryl

AU - Figueiredo, Paulo

AU - Santos, Lurdes

AU - Sarmento, António

AU - Paiva, José Artur

AU - Bacchetta, Matthew

AU - Wilgus, May Lin

AU - Roncon-Albuquerque, Roberto

AU - Brodie, Daniel

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N2 - Background: Severe malaria may be complicated by the acute respiratory distress syndrome (ARDS), which is associated with a high mortality. In the present report, a series of three cases of imported malaria complicated by refractory severe ARDS supported with extracorporeal membrane oxygenation (ECMO) is presented. Methods. One female and two male adult patients (ages 39 to 53) were included. Two patients had Plasmodium falciparum infection and one patient had Plasmodium vivax and Plasmodium ovale co-infection. Anti-malarial therapy consisted in intravenous quinine (in two patients) and intravenous quinidine (in one patient), plus clindamycin or doxycycline. Results: Despite lung protective ventilation, a conservative strategy of fluid management, corticosteroids (two patients), prone position (two patients) and inhaled nitric oxide (one patient), refractory severe ARDS supervened (PaO§ssub§2§esub§ to FiO§ssub§2§esub§ ratio 68) and venovenous ECMO was then initiated. In one patient, a bicaval dual-lumen cannula was inserted; in the two other patients, a two-site configuration was used. Two patients survived to hospital-discharge (duration of ECMO support: 8.5 days) and one patient died from nosocomial sepsis and multi-organ failure after 40 days of ECMO support. Conclusions: ECMO support allowed adequate oxygenation and correction of hypercapnia under lung protective ventilation, therefore reducing ventilator-induced lung injury. ECMO referral should be considered early in malaria complicated by severe ARDS refractory to conventional treatment.

AB - Background: Severe malaria may be complicated by the acute respiratory distress syndrome (ARDS), which is associated with a high mortality. In the present report, a series of three cases of imported malaria complicated by refractory severe ARDS supported with extracorporeal membrane oxygenation (ECMO) is presented. Methods. One female and two male adult patients (ages 39 to 53) were included. Two patients had Plasmodium falciparum infection and one patient had Plasmodium vivax and Plasmodium ovale co-infection. Anti-malarial therapy consisted in intravenous quinine (in two patients) and intravenous quinidine (in one patient), plus clindamycin or doxycycline. Results: Despite lung protective ventilation, a conservative strategy of fluid management, corticosteroids (two patients), prone position (two patients) and inhaled nitric oxide (one patient), refractory severe ARDS supervened (PaO§ssub§2§esub§ to FiO§ssub§2§esub§ ratio 68) and venovenous ECMO was then initiated. In one patient, a bicaval dual-lumen cannula was inserted; in the two other patients, a two-site configuration was used. Two patients survived to hospital-discharge (duration of ECMO support: 8.5 days) and one patient died from nosocomial sepsis and multi-organ failure after 40 days of ECMO support. Conclusions: ECMO support allowed adequate oxygenation and correction of hypercapnia under lung protective ventilation, therefore reducing ventilator-induced lung injury. ECMO referral should be considered early in malaria complicated by severe ARDS refractory to conventional treatment.

KW - Acute respiratory distress syndrome

KW - Extracorporeal membrane oxygenation

KW - Malaria

KW - Plasmodium falciparum

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