Fwd: Fw: A respiratory case on ECMO
Venkat Goyal
From: venkat goyal <venka...@hotmail.com>
Date: Thu, 18 Aug 2011 03:06:18 +0000
Subject: Fw: A respiratory case on ECMO
To: ECMOSOCIETY <ecmosocie...@gmail.com>
Sent from my BlackBerry® smartphone
-----Original Message-----
From: venka...@hotmail.com
Date: Thu, 18 Aug 2011 03:05:12
To: ECMOSOCIETY2<ecmosocie...@hotmail.com>
Reply-To: venka...@hotmail.com
Subject: A respiratory case on ECMO
case summary
46 yrs/M, was admitted with 11/2 month back with giddiness, vomiting
with altered LFT & was diagnosed to have alcoholic hepatitis. He was
discharged after 7 days but developed fever & require
rehospitalization in 2 days. At the time of hospitalization had
convulsion & was investigated & daignosed to be TBM & was treated with
AKT with steroids. He gradually improved with fully conscious , no FND
& steroid was tappered. He became breathless 10 days back & was
diagnosed to have Hospital acquired pnemonia with ARDS. HE was put on
ventilator 7 days back & was maintaining gases with moderate
ventilator settings. but his gases deteriorated since 2 days &
ventilatory requirement increased. he developed Pneumomediastinum &
surgical emphysema & requiring FiO2 100% for more than 24 hrs. His PO2
was 48 with 100% FiO2 with PEEP 0f 10. His PaO2/FiO2 ratio was 48 with
OI of 46. He was considered for ECMO & we were called in.
Indication for ECMO was PaO2/FiO2 ratio - 48, OI - 46 (< 35),
gradually worsenenventilatory parameter, Barotrauma & relatively
behaving like single organ failure.
At the time of initiation of ECMO he had SPO2 for 85% with FiO2 100%.,
haemodynamically stable on noradrenaline support of 0.05mics/kg/min &
surgical emphysema with peak pressure of 46 - 48. He was taken for
VVECMO.(draining cannula - 29F, rt femoral vein, returning cannula -
19 RT IJV) with blood flow of 2.3l/min, sweep gas flow 1:1. Patient's
gases improved with in 15 - 20 mins & was on rest lung settings.At
present he is haemodynamically atable with noradrenaline of 0.03
mics/kg/min. SPO2 98% with FiO2 of 40. u/o ~ 1.5 ml/kg/hr
Dr Pranay
Sent from my BlackBerry® smartphone
--
Dr Venkat S Goyal
Interventional Cardiologist and
Dr Pranay Oza
Intensivist
Office:
ECMO SOCIETY OF INDIA
Riddhivinayak Critical Care & Cardiac Centre
S.V. Road, Malad (West), Mumbai - 400064
Maharashtra (India - Asia)
Tel No: +91 022 28663984 - 89 (6 lines), 66929496,
Fax: +91 022 66943309, Mobile: 9820321815
email: goyal...@yahoo.co.uk