TY - JOUR
T1 - Extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome in severe malaria
AU - Alves, Carlos
AU - Chen, Jen Ting
AU - Patel, Nina
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
PY - 2013
Y1 - 2013
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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U2 - 10.1186/1475-2875-12-306
DO - 10.1186/1475-2875-12-306
M3 - Article
C2 - 24127739
AN - SCOPUS:84883148815
SN - 1475-2875
VL - 12
JO - Malaria Journal
JF - Malaria Journal
IS - 1
M1 - 306
ER -