Early Extracorporeal Membrane Oxygenation in a Patient with Pandemic Influenza (H1N1 2009) and Acute Respiratory Distress Syndrome

Kyong-Hak Lee; Kilsoo Yie; Won Sup Oh; Sook-Won Ryu; Sung-Bin Chon; Seung-Joon Lee

doi:10.3947/ic.2010.42.2.122

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Lee, Yie, Oh, Ryu, Chon, and Lee: Early Extracorporeal Membrane Oxygenation in a Patient with Pandemic Influenza (H1N1 2009) and Acute Respiratory Distress Syndrome

Case Report

Infection & Chemotherapy

Infection & Chemotherapy 2010; 42(2): 122-126.

Published online: 30 April 2010

DOI: https://doi.org/10.3947/ic.2010.42.2.122

Early Extracorporeal Membrane Oxygenation in a Patient with Pandemic Influenza (H1N1 2009) and Acute Respiratory Distress Syndrome

Kyong-Hak Lee¹, Kilsoo Yie¹, Won Sup Oh², Sook-Won Ryu³, Sung-Bin Chon⁴, Seung-Joon Lee²

¹Department of Cardiothoracic surgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea.

²Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea.

³Department of Laboratory Medicine, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea.

⁴Department of Emergency Medicine, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea.

Corresponding author: Won Sup Oh, M.D., Ph.D. Division of Infectious Diseases, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University College of Medicine, 26 Kanwondaehakgil, Chuncheon 200-947, Korea. Tel: +82-33-258-2456, Fax: +82-33-258-9471, wsoh@kangwon.ac.kr

Received 11 April 2010 Accepted 22 April 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Despite advanced technologies in intensive care, pandemic influenza (H1N1 2009) can rapidly progress to acute respiratory distress syndrome (ARDS) and cause death in a small subset of patients. Extracorporeal membrane oxygenation (ECMO) is expected to provide adequate gas exchange, to reduce ventilator-induced lung injury and, eventually, to improve outcome in these patients. A previously healthy, young female received mechanically ventilatory support because of rapidly progressive respiratory failure caused by 2009 H1N1 influenza. As she failed to respond to high ventilatory support, ECMO was instituted at 6 hours after admission. We describe detailed course of case and literature review on ECMO, helping physicians make a decision to initiate ECMO in patients with influenza-related ARDS.

Keywords: Pandemic influenza (H1N1 2009), Acute respiratory distress syndrome, Extracorporeal membrane oxygenation

Figures and Tables

Figure 1

Chest radiography at the 1st (A) and the 4th day (B) of admission.

Figure 2

High resolution computed tomography of the chest at the 2nd (A) and the 7th day (B) of admission.

Table 1

Clinical Course of Case Patient

SBP, lowest systolic blood pressure; DBP, lowest diastolic blood pressure; RR, highest respiratory rate; ACT, activated clotting time; Ct value, cycle threshold; PC, pressure-controlled ventilation; SIMV, simultaneously intermittent mandatory ventilation; SB, spontaneous breath; PEEP, positive end-expiratory pressure; ECMO, extracorporeal membrane oxygenation; OAR, osteltamivir+amantadine+ribavirin; PAR, peramivir+amantadine+ribavirin; CL, ceftriaxone+levofloxacin; TM, teicopalanin+meropenem

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