Behiye Deniz KOSOVALI, Fatma İrem YEŞİLER, Tülay Tunçer PEKER, Mustafa Kemal BAYAR

H1N1 influenza ilişkili akut respiratuar distres sendromunda uzun dönem ekstrakorporeal membran oksijenatör tedavisi ve birçok komplikasyon

Ekstrakorporeal membrane oksijenatörü (ECMO) son yıllarda oldukça gelişmiştir. 2009’daki H1N1 influenza pandemisi sırasında konvansiyonel ventilasyon tekniklerinin başarısız olduğu akut respiratuar distress sendromlu (ARDS) hastalarda venovenöz (VV) ECMO’nun başarılı bir tedavi olduğu gösterildi. Yirmi dokuz yaşında, 38 hafta gebe hastada sezaryen ile doğum sonrası aspirasyon pnömonisi gelişti. Solunum yetmezliği ve hemodinamik instabilite nedeniyle entübe edildi ve vazopresör ajan başlandı. Akciğer grafisinde bilateral nonhomojenöz opasite artışı gözlendi; bu sebeple ARDS ve septik şok tanısı aldı. VVECMO kardiyovasküler cerrahi ekibi tarafından kuruldu ve hasta ECMO ile hastanemize transfer edildi. Hastanede yatışı süresince pnömotoraks, kritik hastalık polinöropatisi, kritik hastalık myopatisi, oksijenatörün pıhtılaşması gibi birçok komplikasyon ortaya çıktı ve hasta başarı ile tedavi edildi.

Anahtar Kelimeler:

Akut respiratuar distress sendromu, Solunum yetmezliği, Yoğun bakım ünitesi, Ekstrakorporal membran oksijenatörü

Long term extracorporeal membrane oxygenation therapy for H1N1 influenza related acute respiratory distress syndrome and several complications

Extracorporeal membrane oxygenation (ECMO) has significantly advanced in recent years. During the 2009 H1N1 inﬂuenza a pandemic, the use of venovenous (VV) ECMO represented a successful rescue treatment for acute respiratory distress syndrome (ARDS) in patients failing conventional ventilation techniques. The patient was thirty nine year-old and 38 weeks pregnant who had a seizure and then aspiration pneumonia occurred. Due to respiratory failure and hemodynamic instability she was intubated and vasopressor agent was initiated. Her chest X ray showed bilateral nonhomogeneous opacity; hence she was diagnosed with severe ARDS and septic shock. VVECMO was applied by a cardiovascular surgery team and the patient was transferred with the ECMO from hospital to our institution. During her hospitalization, multiple complications occurred, such as pneumothorax, critical illness polyneuropathy, clinical illness myopathy, oxygenator clotting and she was treated successfully.

Keywords:

Acute respiratory distress syndrome, Respiratory failure, Intensive care unit, Extracorporal membrane oxygenator,

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