Dataset Information

Successful application of extracorporeal membrane oxygenation treatment in the management of severe respiratory failure caused by primary pulmonary lymphoma: A case report.

ABSTRACT:

Rationale

Primary pulmonary lymphoma (PPL) is a rare disease, and rapid progression of pulmonary exudation leads to severe respiratory failure. Here, we present the case of a critically ill patient with PPL complicated by refractory hypoxemic respiratory failure. The patient was ultimately cured with a successful combination of extracorporeal membrane oxygenation (ECMO) and chemotherapy.

Patient concerns

A 36-year-old woman was hospitalized because of a 2-month history of cough with fever and shortness of breath. Computed tomography revealed multiple pulmonary nodules, consolidation, and solid pulmonary opacities. Complications of pneumothorax occurred after computed tomography-guided core needle biopsy, and respiratory failure progressively developed (PaO2/FiO2 65 mm Hg).

Diagnosis

Primary pulmonary lymphoma, respiratory failure, stress cardiomyopathy, cardiogenic shock.

Interventions

The patient was treated with veno-venous ECMO and chemotherapy.

Outcomes

The patient was successfully weaned off ECMO after chemotherapy and transferred out of the intensive care unit on day 9. After regular chemotherapy, no obvious lesions were observed in either lung tissue.

Conclusion

ECMO can be selected as an important salvage treatment for patients with severe cardiopulmonary dysfunction caused by PPL and other malignant tumors that may be cured or transferred to a stable stage.

SUBMITTER: Yu C

PROVIDER: S-EPMC8797559 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Extracorporeal membrane oxygenation is an established life-saving procedure for severe acute respiratory failure due to various causes. In general, the duration of extracorporeal membrane oxygenation ranges from 1 to 2 weeks, with withdrawal recommended if no improvement is noted. We report a successful case of long-term extracorporeal membrane oxygenation management for respiratory failure due to invasive pulmonary Aspergillus infection.A 64-year-old Asian man with no previous underlying medical conditions was transferred to our hospital for fever and dyspnea. On admission, he presented with bilateral diffuse infiltration shadow on X-ray and chest computed tomography readings, and severe hypoxemia with a partial pressure of oxygen in arterial blood/fraction of inspired oxygen ratio of 55. He was intubated and underwent mechanical ventilation. A bronchial-alveolar lavage was performed prior to administration of antibiotics, and as the bacterial culture was positive for Aspergillus fumigatus, antifungal treatment was then initiated. His respiratory status deteriorated on the 11th admission day, with no improvement on any mechanical ventilator settings. Venous-venous extracorporeal membrane oxygenation was introduced. Extracorporeal membrane oxygenation was used for an extended period of time, with respiratory improvement delayed until the 39th admission day. Extracorporeal membrane oxygenation discontinuation was possible on the 44th day, and he was removed from the ventilator on the 64th day.Long-term extracorporeal membrane oxygenation might be considered if the primary causes of respiratory failure necessitating extracorporeal membrane oxygenation can be expected to be resolved, such as in the case of effective antimicrobial therapy for a definite pathogen. Our case indicates that extracorporeal membrane oxygenation can be used during treatment of respiratory failure due to invasive aspergillosis for the recommended treatment duration of 4 to 8 weeks.

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