ECMO Ýle Tedavi Edilen ARDS Olgusu

Akut Respiratuar Distres Sendromu (ARDS) bilateral radyolojik infiltrasyon ve hipoksemik solunum yetmezliði ile karakterizedir. Kýrk sekiz yaþýnda ev hanýmý pnömoni nedeniyle göðüs hastanesinde tedavi edilirken solunum sýkýntýsý nedeniyle entübe edilmiþ. Üç kez kardiyak arrest geliþen hastaya müdahale edilmiþ yaklaþýk 15 dk. CPR uygulanmýþ. Hasta 3. basamak yoðun bakýma kabul edildiðinde ilk kangazýnda ph’sý 6.9’du ve mix asidozu mevcuttu. Hasta SIMV modda MV’e baðlandý. Solunum sistemi oskültasyonunda bilateral ralleri mevcuttu. PAAC grafisinde atýlmýþ pamuk manzarasý olan hastaya ARDS ön tanýsý koyuldu. Ýnfeksiyon hastalýklarý ile konsulte edilen hastanýn mevcut antibiyoterapisine zyvoxid 2x1 eklendi (avelox 1x1 meronem 2x1). Hastanýn takiplerinde, kültürlerinde herhangi bir üreme saptanmadý.Hastanýn giriþ parametreleri WBC 45000 CRP: 11 mg/dL Sedimantasyon: 84 mg/dL. Hastanýn 2 gün koruyucu ventilasyon stratejisiyle mekanik ventilatörde takip edilmesine raðmen PaO2 / FiO2<100 olmasý, kan gazý deðerlerinin düzelmemesi üzerine ECMO tedavisi kararý verildi. Beþ gün ECMO tedavisi uygulandý. Ardýndan extübe edilen hasta göðüs hastalýklarýna devredilip komplikasyonsuz servise alýndý.

ARDS Case Treated With ECMO

Acute Respiratory Distress Syndrome (ARDS) is characterized with diffuse bilaterat radiologic infiltration, and a hypoxemic respiratory failure. A 48-year-old housewife hospitalized in a chest diseases hospital with the diagnosis of pneumonia was intubated for increased respiratory distress. The patient, who developed cardiac arrest three times underwent CRP for nearly 15 minutes. When she was admitted to intensive care unit of a tertiary healthcare institute, severe acidosis was detected in her first arterial blood gas sample (ph 6.9). Bilateral rales were heard in respiratory system auscultation and “cotton wool spots” were observed on her PA chest X-ray and initial diagnosis of ARDS was made. The patient was consulted with the department of infectious diseases, and zyvoxid 2x1 (avelox 1x1 meronem 2x1) were added to her antibiotherapy. The patient’s admission parameters were as follows: WBC 45000/mm3 CRP: 11 mg/dL sedimentation: 84 mg/dL. Although the patient was followed up on a mechanical ventilator with a protective ventilation strategy for 2 days, ECMO treatment was decided because PaO2 / FiO2 <100 and blood gas values did not improve. ECMO treatment was applied for 5 days. Then, the patient was extubated and transferred to the service without complications.