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Non-heparinized ECMO serves a rescue method in a multitrauma patient combining pulmonary contusion and nonoperative internal bleeding: a case report and literature review.

Wen PH, Chan WH, Chen YC, Chen YL, Chan CP, Lin PY - World J Emerg Surg (2015)

Bottom Line: Although mechanical ventilation is still the first choice of treatment, a group of patients are still unable to maintain their oxygenation.ECMO provides the lung an opportunity to rest by permitting reduced ventilator settings and limiting further barotraumas.The associated literature were reviewed.

View Article: PubMed Central - PubMed

Affiliation: General Surgery Division, Surgery Department, Changhua Christian Hospital, Changhua City, Taiwan ; Trauma Division, Surgery Department, Changhua Christian Hospital, 500 No. 135, Nanxiao Street, Changhua City, Taiwan ; Surgery Department, Cishan Hospital, 84247 No. 60, Zhongxue Rd., Cishan District, Kaohsiung City, Taiwan.

ABSTRACT
Pulmonary contusion and acute respiratory distress syndrome (ARDS) is a common manifestation in polytraumatic patients. Although mechanical ventilation is still the first choice of treatment, a group of patients are still unable to maintain their oxygenation. The role of extracorporeal membrane oxygenation (ECMO) has been more clarified when the lung is extensively damaged and when conventional modality failed. ECMO provides the lung an opportunity to rest by permitting reduced ventilator settings and limiting further barotraumas. However, ECMO is still considered contraindicated in polytramatic patients combining pulmonary contusion and other organ hemorrhage because of systemic anticoagulation during the treatment. We herein report a patient who successfully survive a multitrauma combining pulmonary contusion and grade IV liver laceration using non-heparinized venovenous extracorporeal membrane oxygenation (vv-ECMO). The associated literature were reviewed.

No MeSH data available.


Related in: MedlinePlus

The coronal view and saggital view of abdominal CT showed grade IV laceration over bilateral hemiliver without evident contrast extravasation.
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Fig2: The coronal view and saggital view of abdominal CT showed grade IV laceration over bilateral hemiliver without evident contrast extravasation.

Mentions: A 19-year-old man suffered from a multi-trauma after a traffic accident when he was riding a motorcycle and collided into a car. Upon arrival at our tertiary trauma center, he initially presented with a Glasgow Coma Score of 8 and severe hypoxia. He was intubated immediately. Large amount of food content was sucked from the endotracheal tube. Primary chest computed tomography (CT) reported right lung consolidation with patchy opacities, which was consistent with a combination of blunt chest contusion and aspiration pneumonia (Figure 1). Abdominal CT showed grade IV laceration over bilateral hemiliver without evident contrast extravasation (Figure 2). The gas exchange did not improve despite of mechanical ventilation, and the patient still presented with severe hypoxemia. The parameter about respiration showed PaO2/FiO2: 70.2 under invasive ventilation (pressure-mode inverse ratio ventilation, I:E 2:1). ECMO was thus recommended for lung contusion, aspiration pneumonia and acute pulmonary failure.Figure 1


Non-heparinized ECMO serves a rescue method in a multitrauma patient combining pulmonary contusion and nonoperative internal bleeding: a case report and literature review.

Wen PH, Chan WH, Chen YC, Chen YL, Chan CP, Lin PY - World J Emerg Surg (2015)

The coronal view and saggital view of abdominal CT showed grade IV laceration over bilateral hemiliver without evident contrast extravasation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4359487&req=5

Fig2: The coronal view and saggital view of abdominal CT showed grade IV laceration over bilateral hemiliver without evident contrast extravasation.
Mentions: A 19-year-old man suffered from a multi-trauma after a traffic accident when he was riding a motorcycle and collided into a car. Upon arrival at our tertiary trauma center, he initially presented with a Glasgow Coma Score of 8 and severe hypoxia. He was intubated immediately. Large amount of food content was sucked from the endotracheal tube. Primary chest computed tomography (CT) reported right lung consolidation with patchy opacities, which was consistent with a combination of blunt chest contusion and aspiration pneumonia (Figure 1). Abdominal CT showed grade IV laceration over bilateral hemiliver without evident contrast extravasation (Figure 2). The gas exchange did not improve despite of mechanical ventilation, and the patient still presented with severe hypoxemia. The parameter about respiration showed PaO2/FiO2: 70.2 under invasive ventilation (pressure-mode inverse ratio ventilation, I:E 2:1). ECMO was thus recommended for lung contusion, aspiration pneumonia and acute pulmonary failure.Figure 1

Bottom Line: Although mechanical ventilation is still the first choice of treatment, a group of patients are still unable to maintain their oxygenation.ECMO provides the lung an opportunity to rest by permitting reduced ventilator settings and limiting further barotraumas.The associated literature were reviewed.

View Article: PubMed Central - PubMed

Affiliation: General Surgery Division, Surgery Department, Changhua Christian Hospital, Changhua City, Taiwan ; Trauma Division, Surgery Department, Changhua Christian Hospital, 500 No. 135, Nanxiao Street, Changhua City, Taiwan ; Surgery Department, Cishan Hospital, 84247 No. 60, Zhongxue Rd., Cishan District, Kaohsiung City, Taiwan.

ABSTRACT
Pulmonary contusion and acute respiratory distress syndrome (ARDS) is a common manifestation in polytraumatic patients. Although mechanical ventilation is still the first choice of treatment, a group of patients are still unable to maintain their oxygenation. The role of extracorporeal membrane oxygenation (ECMO) has been more clarified when the lung is extensively damaged and when conventional modality failed. ECMO provides the lung an opportunity to rest by permitting reduced ventilator settings and limiting further barotraumas. However, ECMO is still considered contraindicated in polytramatic patients combining pulmonary contusion and other organ hemorrhage because of systemic anticoagulation during the treatment. We herein report a patient who successfully survive a multitrauma combining pulmonary contusion and grade IV liver laceration using non-heparinized venovenous extracorporeal membrane oxygenation (vv-ECMO). The associated literature were reviewed.

No MeSH data available.


Related in: MedlinePlus