Extracorporeal membrane oxygenation as a bridge to liver transplantation for acute respiratory distress syndrome-induced life-threatening hypoxaemia aggravated by hepatopulmonary syndromeReportar como inadecuado

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Critical Care

, 15:R234

First Online: 29 September 2011Received: 10 March 2011Revised: 04 May 2011Accepted: 29 September 2011


IntroductionCombined with massive lung aeration loss resulting from acute respiratory distress syndrome, hepatopulmonary syndrome, a liver-induced vascular lung disorder characterized by diffuse or localized dilated pulmonary capillaries, may induce hypoxaemia and death in patients with end-stage liver disease.

MethodsThe case of such a patient presenting with both disorders and in whom an extracorporeal membrane oxygenation was used is described.

ResultsA 51-year-old man with a five-year history of alcoholic cirrhosis was admitted for acute respiratory failure, platypnoea and severe hypoxaemia requiring emergency tracheal intubation. Following mechanical ventilation, hypoxaemia remained refractory to positive end-expiratory pressure, 100% of inspired oxygen and inhaled nitric oxide. Two-dimensional contrast-enhanced agitated saline transthoracic echocardiography disclosed a massive right-to-left extracardiac shunt, without patent foramen ovale. Contrast computed tomography CT of the thorax using quantitative analysis and colour encoding system established the diagnosis of acute respiratory distress syndrome aggravated by hepatopulmonary syndrome. According to the severity of the respiratory condition, a veno-venous extracorporeal membrane oxygenation was implemented and the patient was listed for emergency liver transplantation. Orthotopic liver transplantation was performed at Day 13. At the end of the surgical procedure, the improvement in oxygenation allowed removal of extracorporeal membrane oxygenation Day 5. The patient was discharged from hospital at Day 48. Three months after hospital discharge, the patient recovered a correct physical autonomy status without supplemental O2.

ConclusionsIn a cirrhotic patient, acute respiratory distress syndrome was aggravated by hepatopulmonary syndrome causing life-threatening hypoxaemia not controlled by standard supportive measures. The use of extracorporeal membrane oxygenation, by controlling gas exchange, allowed the performing of a successful liver transplantation and final recovery.

KeywordsAcute respiratory distress syndrome hepatopulmonary syndrome hypoxaemia extracorporeal membrane oxygenation orthotopic liver transplantation Abbreviationsγ-GTgamma-glutamyl transpeptidase

ALATalanine aminotransferase

APalkaline phosphatise

ARDSacute respiratory distress syndrome

ASATaspartate amino transferase

CTcomputed tomography

ECMOextracorporeal membrane oxygenation

HPShepatopulmonary syndrome

MVmechanical ventilation


OLTorthotopic liver transplantation

PEEPpositive end-expiratory pressure

PTTprothrombine time

SaO2arterial oxygen saturation

V-V ECMOveno-venous ECMO.

Electronic supplementary materialThe online version of this article doi:10.1186-cc10476 contains supplementary material, which is available to authorized users.

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Autor: Antoine Monsel - Hervé Mal - Hélène Brisson - Rubin Luo - Daniel Eyraud - Corinne Vézinet - Chung Hi Do - Qin Lu - Je

Fuente: https://link.springer.com/

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