After a dental abscess, an 18-year-old diabetic woman became febrile, dyspneic, confused, and oliguric. In spite of treatment with insulin, antibiotics and diuretics, the condition progressed toward acute respiratory and renal failure with complete anuria, coma, hypotensive episodes, diffuse lung fields opacification and hypoxemia. The progressive deteriorating respiratory function could not be corrected by mechanical ventilation, which was maintained for 42 days, coupled with hemodialysis every other day. At that point, the patient met the 'slow entry' criteria of the NIH-sponsored Extracorporeal Memberane Oxygenation (ECMO) study. She received respiratory support in the form of veno-venous bypass (about 25% of cardiac output) through a spiral coil membrane lung for the purpose of extracorporeal CO2 removal associated with low frequency (2-4 cycles/min) positive pressure ventilation with an oxygen-enriched gas mixture. After six days of such treatment, combined with intensive hemodialysis and antibiotic therapy, the patient improved sufficiently to allow weaning from the veno-venous extracorporeal circulation procedure. Renal function and spontaneous breathing with room air became adequate eight days later, and the patient was eventually discharged after another month of treatment. Two years later, the pulmonary function tests appear to be within the normal range, and the diabetes is adequately controlled with insulin.
|Number of pages||6|
|Publication status||Published - 1983|
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