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Case Report of Patients with Acute Respiratory Distress Syndrome Caused by COVID-19: Successfully Treated by Venovenous Extracorporeal Membrane Oxygenation and an Ultra-Protective Ventilation.
Medicina (Kaunas). 2020 Oct 29; 56(11)M

Abstract

Coronavirus disease (COVID-19) started in Wuhan (China) at the end of 2019, and then increased rapidly. In patients with severe acute respiratory distress syndrome (ARDS) caused by COVID-19, venovenous extracorporeal membrane oxygenation (VV-ECMO) is considered a rescue therapy that provides adequate gas exchange. The way in which mechanical ventilation is applied during VV-ECMO is not clear, however it is associated with prognosis. Currently, the mortality rate of COVID-19 patients that receive VV-ECMO stands at approximately 50%. Here, we report three patients that successfully recovered from COVID-19-induced ARDS after VV-ECMO and implementation of an ultra-protective ventilation. This ventilation strategy involved maintaining a peak inspiratory pressure of ≤20 cmH2O and a positive end-expiratory pressure (PEEP) of ≤ 10 cmH2O, which are lower values than have been previously reported. Thus, we suggest that this ultra-protective ventilation be considered during VV-ECMO as it minimizes the ventilator-induced lung injury.

Authors+Show Affiliations

Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Incheon 22332, Korea.Division of Critical Care Medicine, Department of Internal Medicine, Inha University Hospital, Incheon 22332, Korea.Division of Critical Care Medicine, Department of Internal Medicine, Inha University Hospital, Incheon 22332, Korea.Division of Thoracic Surgery, Inha University Hospital, Incheon 22332, Korea.Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Incheon 22332, Korea.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

33137936

Citation

Park, Mi Hwa, et al. "Case Report of Patients With Acute Respiratory Distress Syndrome Caused By COVID-19: Successfully Treated By Venovenous Extracorporeal Membrane Oxygenation and an Ultra-Protective Ventilation." Medicina (Kaunas, Lithuania), vol. 56, no. 11, 2020.
Park MH, Kim AJ, Lee MJ, et al. Case Report of Patients with Acute Respiratory Distress Syndrome Caused by COVID-19: Successfully Treated by Venovenous Extracorporeal Membrane Oxygenation and an Ultra-Protective Ventilation. Medicina (Kaunas). 2020;56(11).
Park, M. H., Kim, A. J., Lee, M. J., Kim, Y. S., & Kim, J. S. (2020). Case Report of Patients with Acute Respiratory Distress Syndrome Caused by COVID-19: Successfully Treated by Venovenous Extracorporeal Membrane Oxygenation and an Ultra-Protective Ventilation. Medicina (Kaunas, Lithuania), 56(11). https://doi.org/10.3390/medicina56110570
Park MH, et al. Case Report of Patients With Acute Respiratory Distress Syndrome Caused By COVID-19: Successfully Treated By Venovenous Extracorporeal Membrane Oxygenation and an Ultra-Protective Ventilation. Medicina (Kaunas). 2020 Oct 29;56(11) PubMed PMID: 33137936.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Case Report of Patients with Acute Respiratory Distress Syndrome Caused by COVID-19: Successfully Treated by Venovenous Extracorporeal Membrane Oxygenation and an Ultra-Protective Ventilation. AU - Park,Mi Hwa, AU - Kim,Ah Jin, AU - Lee,Man-Jong, AU - Kim,Young Sam, AU - Kim,Jung Soo, Y1 - 2020/10/29/ PY - 2020/09/21/received PY - 2020/10/23/revised PY - 2020/10/26/accepted PY - 2020/11/3/entrez PY - 2020/11/4/pubmed PY - 2020/11/6/medline KW - COVID-19 KW - acute respiratory distress syndrome KW - ultra-protective ventilation KW - venovenous extracorporeal membrane oxygenation JF - Medicina (Kaunas, Lithuania) JO - Medicina (Kaunas) VL - 56 IS - 11 N2 - Coronavirus disease (COVID-19) started in Wuhan (China) at the end of 2019, and then increased rapidly. In patients with severe acute respiratory distress syndrome (ARDS) caused by COVID-19, venovenous extracorporeal membrane oxygenation (VV-ECMO) is considered a rescue therapy that provides adequate gas exchange. The way in which mechanical ventilation is applied during VV-ECMO is not clear, however it is associated with prognosis. Currently, the mortality rate of COVID-19 patients that receive VV-ECMO stands at approximately 50%. Here, we report three patients that successfully recovered from COVID-19-induced ARDS after VV-ECMO and implementation of an ultra-protective ventilation. This ventilation strategy involved maintaining a peak inspiratory pressure of ≤20 cmH2O and a positive end-expiratory pressure (PEEP) of ≤ 10 cmH2O, which are lower values than have been previously reported. Thus, we suggest that this ultra-protective ventilation be considered during VV-ECMO as it minimizes the ventilator-induced lung injury. SN - 1648-9144 UR - https://www.unboundmedicine.com/medline/citation/33137936/Case_Report_of_Patients_with_Acute_Respiratory_Distress_Syndrome_Caused_by_COVID_19:_Successfully_Treated_by_Venovenous_Extracorporeal_Membrane_Oxygenation_and_an_Ultra_Protective_Ventilation_ L2 - https://www.mdpi.com/resolver?pii=medicina56110570 DB - PRIME DP - Unbound Medicine ER -