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Varicella associated acute respiratory distress syndrome in an adult patient: an example for extracorporeal respiratory support in Brazilian endemic diseases

Abstracts

A case of a 30 year-old man presenting with severe systemic chickenpox with refractory hypoxemia, central nervous system vasculitis and anuric renal failure is described. Ambulance transportation and support using veno-venous extracorporeal membrane oxygenation were necessary until the patient recovered. Ultimately, the potential use of extracorporeal membrane oxygenation support in low-middle income countries to manage common diseases is discussed.

Extracorporeal membrane oxygenation; Respiratory failure; Respiration, artificial; Chickenpox; Intensive care units; Case reports


Descreveu-se aqui o caso de um homem de 30 anos de idade com quadro de varicela grave, hipoxemia refratária, vasculite do sistema nervoso central e insuficiência renal anúrica. Foi necessário transporte por ambulância com suporte respiratório extracorpóreo veno-venoso, sendo este utilizado até a recuperação do paciente. Discute-se o potencial uso de oxigenação por membrana extracorpórea em países em desenvolvimento para o controle de doenças comuns nestas áreas.

Oxigenação por membrana extracorpórea; Insuficiência respiratória; Respiração artificial; Varicela; Unidades de terapia intensiva; Relatos de casos


INTRODUCTION

Worldwide, several infectious diseases have a high mortality rate. Three of the top ten causes of death listed by the World Health Organization are infectious diseases.(1World Health Organization. The top 10 causes of death: World Health Organization; 2014 [updated 2014-05-20 19:17:4420 Jul 2014]. [cited 2014 Oct 15]. Available from: http://www.who.int/mediacentre/factsheets/fs310/en/
http://www.who.int/mediacentre/factsheet...
) Additionally, new infectious agents are occasionally detected, some of which result in a high number of fatalities, such as influenza A (H1N1) in 2009.

Primary varicella, or chickenpox, is usually a benign childhood illness. Despite the fact that fewer than 10% of cases occur in adults, the risk of death for adults with chickenpox is 23 to 29 times higher than in children.(2Heininger U, Seward JF. Varicella. Lancet. 2006;368(9544):1365-76. Review.) Furthermore, pneumonitis is the most serious complication and the most common cause of death among adults with this illness.(3Joseph CA, Noah ND. Epidemiology of chickenpox in England and Wales, 1967-85. Br Med J (Clin Res Ed). 1988;296(6623):673-6.) We report a case of chickenpox in a non-immunocompromised adult with severe pneumonitis, central nervous vasculitis and acute renal failure who needed veno-venous extracorporeal membrane oxygenation (ECMO) support.

CASE PRESENTATION

A previously heathy 30 year-old man was admitted to the emergency room with a five day history of cutaneous vesicles, fever and dyspnea. His daughter was in the convalescence phase of chickenpox. He was cyanotic and in moderate respiratory distress. The chest x-ray and appearance of the skin at the time the patient presented are shown in figures 1A and 1B, respectively.

Figure 1
Thoracic and central nervous system images. (A) The chest X-Ray after ECMO cannulation; (B) The cutaneous appearance of the patient. (C) The chest X-Ray on the day of ICU discharge; (D) The central nervous system tomography, the arrows indicate two of the multiple focal bleedings.

The clinical diagnosis was chickenpox with pulmonary manifestation. At this time, renal and hemodynamic functions were normal. Therapy with acyclovir was initiated, and the patient was admitted to the intensive care unit (ICU) for monitoring and respiratory support. On the first day of ICU stay, he developed unrelenting respiratory distress; he was intubated, and mechanical ventilation was initiated. His hemodynamic and renal status deteriorated. During the first week of ICU stay, he required up to 0.3mcg/kg/minute of norepinephrine, and the cumulative fluid balance was positive at approximately 40 liters despite peritoneal dialysis. In addition to the renal and hemodynamic dysfunctions, his pulmonary function also deteriorated, and he developed severe hypoxemia on the eighth day after admission (Table 1). This condition was unresponsive to an alveolar recruitment maneuver and a positive end-expiratory pressure (PEEP) of 22cmH2O (Table 1). At this time, it was thought that the patient had ventilator associated pneumonia, and he was treated with vancomycin and imipenem. Next, ECMO support was indicated, and the ECMO group Hospital das Clínicas de São Paulo was contacted. The patient was cannulated in situ using a percutaneous technique with 19 and 21 French cannulaes through the left jugular (atrial cannula) and femoral (drainage cannula) veins, respectively. The venous-venous ECMO support was initiated with 5L/minute of blood and gas flow. The mechanical ventilation was adjusted with PEEP=10cmH2O, driving pressure=10cmH2O, respiratory rate=10 breaths/minute, and the ventilator FiO2 was progressively lowered to 0.6. The norepinephrine infusion was promptly stopped due to hemodynamic improvement. The patient developed diffuse cutaneous and conjunctive petechiaes, highly suggestive of vasculitis; therefore, anticoagulation with heparin was not initiated due to the possibility of central nervous system bleeding, once tomography was not locally available and the Richmond agitation sedation scale (RASS) was minus five.

Table 1
Respiratory, hemodynamic and metabolic characteristics of the patient

After four hours of clinical stabilization, the ECMO support was adjusted to 6L/minute of blood flow and 8L/minute of gas flow, and the mechanical ventilation settings were kept the same. Transportation by ambulance to downtown São Paulo City was required, which is a 156km journey lasting approximately two hours. For the transport, the ventilator FiO2 was increased to 1.0.

After transportation, the ventilator FiO2 was reduced again to 0.6, and the other ECMO and ventilator variables were similar to those used in the stabilization period. Continuous venous - venous hemofiltration was initiated with a progressively higher ultrafiltration rate, up to 350mL/hour. During the first day, the peripheral oxygen saturation (SpO2) dropped to 65%, despite ventilator FiO2 and ECMO blood flow elevations to 1.0 and 6500mL/minute, respectively. At this point, a diagnosis of ECMO refractory hypoxemia was made. ECMO refractory hypoxemia has been defined as a PaO2<50mmHg (taking precedence) or an arterial saturation persistently lower than 85%.(4Nunes LB, Mendes PV, Hirota AS, Barbosa EV, Maciel AT, Schettino GP, Costa EL, Azevedo LC, Park M; ECMO Group. Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support. Clinics (São Paulo). 2014;69(3):173-8.) In our patient, as the ECMO running time was <24 hours, the difference of color between the drainage and atrium cannulaes was significant (despite high ECMO blood flow), and the pulmonary injury was severe (white lung on the x-ray - Figure 1A and respiratory static compliance=1.2mL/cmH2O - Table 1), the diagnosis of ECMO blood re-circulation and artificial lung dysfunction was dismissed. ECMO refractory hypoxemia was attributed to the association between severely decreased native lung function and a low ECMO blood flow/cardiac output ratio.(4Nunes LB, Mendes PV, Hirota AS, Barbosa EV, Maciel AT, Schettino GP, Costa EL, Azevedo LC, Park M; ECMO Group. Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support. Clinics (São Paulo). 2014;69(3):173-8.)

Therefore, a stepwise alveolar recruitment maneuver was performed using PEEPs from 25 to 45cmH2O, with a driving pressure=15cmH2O, an inspiratory time=3 seconds and a respiratory rate=10 breaths/minutes. After the initial PEEP=25cmH2O, each step lasted 2 minutes, and the PEEPs used were 30, 25, 35, 25, 40, 25, 45, 25cmH2O sequentially, as previously described.(5Borges JB, Okamoto VN, Matos GF, Caramez MP, Arantes PR, Barros F, et al. Reversibility of lung collapse and hypoxemia in early acute respiratory distress syndrome. Am J Respir Crit Care Med. 2006;174(3):268-78.) Finally, the ideal PEEP was titrated using the pressure point 2cmH2O above the best dynamic respiratory compliance (Cdyn), measuring the Cdyn after the alveolar recruitment maneuver and decreasing the PEEP from 25cmH2O each 2 minutes in 2cmH2O steps, as previously described.(6Suarez-Sipmann F, Böhm SH, Tusman G, Pesch T, Thamm O, Reissmann H, et al. Use of dynamic compliance for open lung positive end-expiratory pressure titration in an experimental study. Crit Care Med. 2007;35(1):214-21.) The ideal PEEP measured was 25cmH2O, which was used with a driving pressure of 5cmH2O, inspiratory time=1 second, and a respiratory rate=10 breaths/minute. The SpO2 30 minutes after the alveolar recruitment maneuver and PEEP titration increased to 84%.

During the next twelve hours, the SpO2 progressively increased to 92%. After this period, the ventilator FiO2 and PEEP were gradually reduced, keeping the SpO2≥85%. After four days, the patient was comfortable and ventilating with a PEEP=15cmH2O, pressure support=6cmH2O and FiO2=0.3. The ECMO autonomy test was performed, setting the gas flow=0L/minute for 1 hour, as previously described.(7Park M, Azevedo LC, Mendes PV, Carvalho CR, Amato MB, Schettino GP, et al. First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation. Clinics (São Paulo). 2012;67(10):1157-63.) The chest x-ray at this point is shown in figure 1C. After ECMO decanulation, a central nervous system tomography was performed and showed multiple bleeding areas, which were highly suggestive of vasculitis (Figure 1D).

Sedation was withdrawn, and after 24 hours the patient was unresponsive with scanning movement of eyes. A tracheostomy was performed, and the mechanical ventilation was withdrawn. After eleven days, the patient was discharged from the ICU, the neurologic and renal function gradually recovered, and after thirty three days he was discharged from the hospital to his home.

DISCUSSION

ECMO respiratory support has been used worldwide to sustain the lives of patients with severe respiratory failure. The mortality associated with infectious diseases has been reduced in Brazil during the last decade. However, these infectious diseases are still the main cause of severe respiratory failure in middle income countries.(8Barreto ML, Teixeira MG, Bastos FI, Ximenes RA, Barata RB, Rodrigues LC. Successes and failures in the control of infectious diseases in Brazil: social and environmental context, policies, interventions, and research needs. Lancet. 2011;377(9780):1877-89.) Therefore, we would like to discuss the use of ECMO to support patients with some endemic infectious diseases in low-middle income countries, such as Brazil.

In England, from 1995 to 1997, seventy five adult patients died due to severe chickenpox (9.07/1,000,000 deaths), representing a mean of 25 deaths per year. From those 75 patients, sixty died primarily due to chickenpox with severe respiratory failure. The majority of deaths were in young adult men (81%).(9Rawson H, Crampin A, Noah N. Deaths from chickenpox in England and Wales 1995-7: analysis of routine mortality data. BMJ. 2001;323(7321):1091-3.) Among adult and pediatric patients, viral pneumonia was the cause of severe respiratory failure in 27% of patients who required ECMO. Furthermore, up to 18% of these ECMO supported patients were young (mean age of 33 years old) and were diagnosed with severe chickenpox.(1010 Lee WA, Kolla S, Schreiner RJ Jr, Hirschl RB, Bartlett RH. Prolonged extracorporeal life support (ECLS) for varicella pneumonia. Crit Care Med. 1997;25(6):977-82.) Overall survival was 57-71%,(1010 Lee WA, Kolla S, Schreiner RJ Jr, Hirschl RB, Bartlett RH. Prolonged extracorporeal life support (ECLS) for varicella pneumonia. Crit Care Med. 1997;25(6):977-82.,1111 White RW, Peek GJ, Jenkins DR, Killer HM, Firmin RK. Extracorporeal membrane oxygenation for chickenpox pneumonia: a single institution's experience. ASAIO J. 2003;49(4):378-82.) the median time on ECMO support was seven days, and renal replacement therapy was necessary in 71% of patients.(1111 White RW, Peek GJ, Jenkins DR, Killer HM, Firmin RK. Extracorporeal membrane oxygenation for chickenpox pneumonia: a single institution's experience. ASAIO J. 2003;49(4):378-82.) ECMO support has been considered an important adjunct therapy in severe chickenpox in high-income countries.(1212 Roberts N, Peek GJ, Jones N, Firmin RK, Elbourne D. Deaths from Chickenpox. Extracorporeal membrane oxygenation has important role. BMJ. 2002;324(7337):610-1.) The severe renal and respiratory dysfunction both contributed to the hypoxemia of our patient. Moreover, the ECMO support allowed for the safe transportation of the patient in addition to sufficient time for the renal replacement therapy to be effective. The clinical approach for severe hypoxemia during ECMO support is discussed elsewhere.(4Nunes LB, Mendes PV, Hirota AS, Barbosa EV, Maciel AT, Schettino GP, Costa EL, Azevedo LC, Park M; ECMO Group. Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support. Clinics (São Paulo). 2014;69(3):173-8.)

The influenza A H1N1 epidemics in 2009 had a hugely negative impact in Brazilian tertiary hospitals,(1313 Schout D, Hajjar LA, Galas FR, Uip DE, Levin AS, Caiaffa Filho HH, et al. Epidemiology of human infection with the novel virus influenza A (H1N1) in the Hospital das Clinicas, São Paulo, Brazil-June-September 2009. Clinics (São Paulo). 2009;64(10):1025-30.) resulting in unprecedented organizational responses.(1414 Hajjar LA, Schout D, Galas FR, Uip DE, Levin AS, Caiaffa Filho HH, et al. Guidelines on management of human infection with the novel virus influenza A (H1N1)-a report from the Hospital das Clínicas of the University of São Paulo. Clinics (São Paulo). 2009;64(10):1015-24.) However, despite the local and government emergency measures, the case-fatality was higher than in other countries, mainly due to severe respiratory failure.(1313 Schout D, Hajjar LA, Galas FR, Uip DE, Levin AS, Caiaffa Filho HH, et al. Epidemiology of human infection with the novel virus influenza A (H1N1) in the Hospital das Clinicas, São Paulo, Brazil-June-September 2009. Clinics (São Paulo). 2009;64(10):1025-30.) In high income countries, the H1N1 pandemics led to extreme advanced resource mobilization in order to offer ECMO support to a high number of patients concomitantly. In Australia, elective surgeries, especially cardiac surgery, were suspended to open ICU beds and to re-allocate perfusion devices for ECMO support in the ICU.(1515 Forrest P, Ratchford J, Burns B, Herkes R, Jackson A, Plunkett B, et al. Retrieval of critically ill adults using extracorporeal membrane oxygenation: an Australian experience. Intensive Care Med. 2011;37(5):824-30.,1616 Nair P, Davies AR, Beca J, Bellomo R, Ellwood D, Forrest P, et al. Extracorporeal membrane oxygenation for severe ARDS in pregnant and postpartum women during the 2009 H1N1 pandemic. Intensive Care Med. 2011;37(4):648-54.) This policy resulted in a high number of ECMO supported patients and a high survival rate (78%).(1717 Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators, Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, et al. Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome. JAMA. 2009;302(17):1888-95.) In England, three novel ECMO centers were built during the epidemics, and there was a high survival rate (76%).(1818 Noah MA, Peek GJ, Finney SJ, Griffiths MJ, Harrison DA, Grieve R, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA. 2011;306(15):1659-68.) Other countries also needed to improve their ECMO support facilities during the H1N1 crisis, resulting in encouraging outcomes.(1919 Pham T, Combes A, Rozé H, Chevret S, Mercat A, Roch A, Mourvillier B, Ara-Somohano C, Bastien O, Zogheib E, Clavel M, Constan A, Marie Richard JC, Brun-Buisson C, Brochard L; REVA Research Network. Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. Am J Respir Crit Care Med. 2013;187(3):276-85.,2020 Cianchi G, Bonizzoli M, Pasquini A, Bonacchi M, Zagli G, Ciapetti M, et al. Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure: results of an Italian referral ECMO center. BMC Pulm Med. 2011;11:2.)

Malaria is another low-middle income country disease that potentially results in severe respiratory failure needing ECMO support. Plasmodium vivax and Plasmodium falciparum are the etiologies of respiratory failure in patients who required ECMO support. It is interesting to note that the ECMO support that is described in the literature was in patients who emigrated from low-middle income regions to high-income regions, likely reflecting the cultural - economical incapacity of low-middle income countries to control the disease or to offer adequate support for the victims of severe malaria.(2121 Alves C, Chen JT, Patel N, Abrams D, Figueiredo P, Santos L, et al. Extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome in severe malaria. Malar J. 2013;12:306.,2222 Losert H, Schmid K, Wilfing A, Winkler S, Staudinger T, Kletzmayr J, et al. Experiences with severe P. falciparum malaria in the intensive care unit. Intensive Care Med. 2000;26(2):195-201.)

The Hantaan virus cardio-respiratory syndrome presentation with severe hypoxemia and refractory cardiovascular failure is associated with 100% mortality.(2323 Crowley MR, Katz RW, Kessler R, Simpson SQ, Levy H, Hallin GW, et al. Successful treatment of adults with severe Hantavirus pulmonary syndrome with extracorporeal membrane oxygenation. Crit Care Med. 1998;26(2):409-14.) Although veno-arterial ECMO support has been described to support (cardiovascular and respiratory support) those patients with high death probability, with a survival rate of 61%.(2424 Dietl CA, Wernly JA, Pett SB, Yassin SF, Sterling JP, Dragan R, et al. Extracorporeal membrane oxygenation support improves survival of patients with severe Hantavirus cardiopulmonary syndrome. J Thorac Cardiovasc Surg. 2008;135(3):579-84.,2525 Wernly JA, Dietl CA, Tabe CE, Pett SB, Crandall C, Milligan K, et al. Extracorporeal membrane oxygenation support improves survival of patients with Hantavirus cardiopulmonary syndrome refractory to medical treatment. Eur J Cardiothorac Surg. 2011;40(6):1334-40.)

Leptospirosis is a frequent tropical fever disease that can present with severe hypoxemia and alveolar hemorrhage.(2626 Carvalho CR, Bethlem EP. Pulmonary complications of leptospirosis. Clin Chest Med. 2002;23(2):469-78. Review.) The severe cardiovascular and respiratory failure can be refractory to optimized ICU therapy;(2626 Carvalho CR, Bethlem EP. Pulmonary complications of leptospirosis. Clin Chest Med. 2002;23(2):469-78. Review.) therefore, in this scenario, respiratory and cardiovascular ECMO support has been successfully used.(2727 Kahn JM, Müller HM, Kulier A, Keusch-Preininger A, Tscheliessnigg KH. Veno-arterial extracorporeal membrane oxygenation in acute respiratory distress syndrome caused by leptospire sepsis. Anesth Analg. 2006;102(5):1597-8.) We would like to emphasize that the hemorrhagic lung disease did not prevent the success of ECMO support.(2828 Arokianathan D, Trower K, Pooboni S, Sosnowski A, Moss P, Thaker H. Leptospirosis: a case report of a patient with pulmonary haemorrhage successfully managed with extra corporeal membrane oxygenation. J Infect. 2005;50(2):158-62.)

Tuberculosis is a prevalent disease in low-middle income countries and is a major health concern. However, severe respiratory and cardiovascular failure are not common. Those more severely ill patients have been supported with veno-arterial and/or veno-venous ECMO.(2929 Petrillo TM, Heard ML, Fortenberry JD, Stockwell JA, Leonard MK Jr. Respiratory failure caused by tuberculous pneumonia requiring extracorporeal membrane oxygenation. Perfusion. 2001;16(6):525-9.,3030 Homan W, Harman E, Braun NM, Felton CP, King TK, Smith JP. Miliary tuberculosis presenting as acute respiratory failure: treatment by membrane oxygenator and ventricle pump. Chest. 1975;67(3):366-9.) Those descriptions of ECMO supported patients with tuberculosis were also in high income countries.

The incidence of dengue has increased 30 fold worldwide over the last 50 years. In 2014, several Brazilian states noted a significant rise in cases, with more than two hundred deaths.(3131 Secretaria de Vigilância em Saúde. Ministério da Saúde. Dengue: monitoramento até a Semana Epidemiológica (SE) 27 de 2014. Bol Epidemiol. 2014;45(16):1-6.) Although pulmonary hemorrhage is not frequent in severe dengue, the presence of pulmonary edema, pleural effusion and ARDS are associated with a high mortality.(3232 Lee IK, Liu JW, Yang KD. Fatal dengue hemorrhagic fever in adults: emphasizing the evolutionary pre-fatal clinical and laboratory manifestations. PLoS Negl Trop Dis. 2012;6(2):e1532.,3333 Ong A, Sandar M, Chen MI, Sin LY. Fatal dengue hemorrhagic fever in adults during a dengue epidemic in Singapore. Int J Infect Dis. 2007;11(3):263-7.) ECMO can be a feasible alternative support for this condition.

CONCLUSION

There are many prevalent diseases in low-middle income countries (such as Brazil) that affect the young, economically active population and that potentially cause severe respiratory and cardiovascular failure. The main policy of public health authorities must be focused on disease control. Secondarily, some tertiary centers must be able to provide advanced respiratory and cardiovascular ECMO support for safe transportation and adequate care for those more severely ill patients.

  • Responsible editor: Thiago Costa Lisboa

REFERÊNCIAS

  • 1
    World Health Organization. The top 10 causes of death: World Health Organization; 2014 [updated 2014-05-20 19:17:4420 Jul 2014]. [cited 2014 Oct 15]. Available from: http://www.who.int/mediacentre/factsheets/fs310/en/
    » http://www.who.int/mediacentre/factsheets/fs310/en/
  • 2
    Heininger U, Seward JF. Varicella. Lancet. 2006;368(9544):1365-76. Review.
  • 3
    Joseph CA, Noah ND. Epidemiology of chickenpox in England and Wales, 1967-85. Br Med J (Clin Res Ed). 1988;296(6623):673-6.
  • 4
    Nunes LB, Mendes PV, Hirota AS, Barbosa EV, Maciel AT, Schettino GP, Costa EL, Azevedo LC, Park M; ECMO Group. Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support. Clinics (São Paulo). 2014;69(3):173-8.
  • 5
    Borges JB, Okamoto VN, Matos GF, Caramez MP, Arantes PR, Barros F, et al. Reversibility of lung collapse and hypoxemia in early acute respiratory distress syndrome. Am J Respir Crit Care Med. 2006;174(3):268-78.
  • 6
    Suarez-Sipmann F, Böhm SH, Tusman G, Pesch T, Thamm O, Reissmann H, et al. Use of dynamic compliance for open lung positive end-expiratory pressure titration in an experimental study. Crit Care Med. 2007;35(1):214-21.
  • 7
    Park M, Azevedo LC, Mendes PV, Carvalho CR, Amato MB, Schettino GP, et al. First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation. Clinics (São Paulo). 2012;67(10):1157-63.
  • 8
    Barreto ML, Teixeira MG, Bastos FI, Ximenes RA, Barata RB, Rodrigues LC. Successes and failures in the control of infectious diseases in Brazil: social and environmental context, policies, interventions, and research needs. Lancet. 2011;377(9780):1877-89.
  • 9
    Rawson H, Crampin A, Noah N. Deaths from chickenpox in England and Wales 1995-7: analysis of routine mortality data. BMJ. 2001;323(7321):1091-3.
  • 10
    Lee WA, Kolla S, Schreiner RJ Jr, Hirschl RB, Bartlett RH. Prolonged extracorporeal life support (ECLS) for varicella pneumonia. Crit Care Med. 1997;25(6):977-82.
  • 11
    White RW, Peek GJ, Jenkins DR, Killer HM, Firmin RK. Extracorporeal membrane oxygenation for chickenpox pneumonia: a single institution's experience. ASAIO J. 2003;49(4):378-82.
  • 12
    Roberts N, Peek GJ, Jones N, Firmin RK, Elbourne D. Deaths from Chickenpox. Extracorporeal membrane oxygenation has important role. BMJ. 2002;324(7337):610-1.
  • 13
    Schout D, Hajjar LA, Galas FR, Uip DE, Levin AS, Caiaffa Filho HH, et al. Epidemiology of human infection with the novel virus influenza A (H1N1) in the Hospital das Clinicas, São Paulo, Brazil-June-September 2009. Clinics (São Paulo). 2009;64(10):1025-30.
  • 14
    Hajjar LA, Schout D, Galas FR, Uip DE, Levin AS, Caiaffa Filho HH, et al. Guidelines on management of human infection with the novel virus influenza A (H1N1)-a report from the Hospital das Clínicas of the University of São Paulo. Clinics (São Paulo). 2009;64(10):1015-24.
  • 15
    Forrest P, Ratchford J, Burns B, Herkes R, Jackson A, Plunkett B, et al. Retrieval of critically ill adults using extracorporeal membrane oxygenation: an Australian experience. Intensive Care Med. 2011;37(5):824-30.
  • 16
    Nair P, Davies AR, Beca J, Bellomo R, Ellwood D, Forrest P, et al. Extracorporeal membrane oxygenation for severe ARDS in pregnant and postpartum women during the 2009 H1N1 pandemic. Intensive Care Med. 2011;37(4):648-54.
  • 17
    Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators, Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, et al. Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome. JAMA. 2009;302(17):1888-95.
  • 18
    Noah MA, Peek GJ, Finney SJ, Griffiths MJ, Harrison DA, Grieve R, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA. 2011;306(15):1659-68.
  • 19
    Pham T, Combes A, Rozé H, Chevret S, Mercat A, Roch A, Mourvillier B, Ara-Somohano C, Bastien O, Zogheib E, Clavel M, Constan A, Marie Richard JC, Brun-Buisson C, Brochard L; REVA Research Network. Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. Am J Respir Crit Care Med. 2013;187(3):276-85.
  • 20
    Cianchi G, Bonizzoli M, Pasquini A, Bonacchi M, Zagli G, Ciapetti M, et al. Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure: results of an Italian referral ECMO center. BMC Pulm Med. 2011;11:2.
  • 21
    Alves C, Chen JT, Patel N, Abrams D, Figueiredo P, Santos L, et al. Extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome in severe malaria. Malar J. 2013;12:306.
  • 22
    Losert H, Schmid K, Wilfing A, Winkler S, Staudinger T, Kletzmayr J, et al. Experiences with severe P. falciparum malaria in the intensive care unit. Intensive Care Med. 2000;26(2):195-201.
  • 23
    Crowley MR, Katz RW, Kessler R, Simpson SQ, Levy H, Hallin GW, et al. Successful treatment of adults with severe Hantavirus pulmonary syndrome with extracorporeal membrane oxygenation. Crit Care Med. 1998;26(2):409-14.
  • 24
    Dietl CA, Wernly JA, Pett SB, Yassin SF, Sterling JP, Dragan R, et al. Extracorporeal membrane oxygenation support improves survival of patients with severe Hantavirus cardiopulmonary syndrome. J Thorac Cardiovasc Surg. 2008;135(3):579-84.
  • 25
    Wernly JA, Dietl CA, Tabe CE, Pett SB, Crandall C, Milligan K, et al. Extracorporeal membrane oxygenation support improves survival of patients with Hantavirus cardiopulmonary syndrome refractory to medical treatment. Eur J Cardiothorac Surg. 2011;40(6):1334-40.
  • 26
    Carvalho CR, Bethlem EP. Pulmonary complications of leptospirosis. Clin Chest Med. 2002;23(2):469-78. Review.
  • 27
    Kahn JM, Müller HM, Kulier A, Keusch-Preininger A, Tscheliessnigg KH. Veno-arterial extracorporeal membrane oxygenation in acute respiratory distress syndrome caused by leptospire sepsis. Anesth Analg. 2006;102(5):1597-8.
  • 28
    Arokianathan D, Trower K, Pooboni S, Sosnowski A, Moss P, Thaker H. Leptospirosis: a case report of a patient with pulmonary haemorrhage successfully managed with extra corporeal membrane oxygenation. J Infect. 2005;50(2):158-62.
  • 29
    Petrillo TM, Heard ML, Fortenberry JD, Stockwell JA, Leonard MK Jr. Respiratory failure caused by tuberculous pneumonia requiring extracorporeal membrane oxygenation. Perfusion. 2001;16(6):525-9.
  • 30
    Homan W, Harman E, Braun NM, Felton CP, King TK, Smith JP. Miliary tuberculosis presenting as acute respiratory failure: treatment by membrane oxygenator and ventricle pump. Chest. 1975;67(3):366-9.
  • 31
    Secretaria de Vigilância em Saúde. Ministério da Saúde. Dengue: monitoramento até a Semana Epidemiológica (SE) 27 de 2014. Bol Epidemiol. 2014;45(16):1-6.
  • 32
    Lee IK, Liu JW, Yang KD. Fatal dengue hemorrhagic fever in adults: emphasizing the evolutionary pre-fatal clinical and laboratory manifestations. PLoS Negl Trop Dis. 2012;6(2):e1532.
  • 33
    Ong A, Sandar M, Chen MI, Sin LY. Fatal dengue hemorrhagic fever in adults during a dengue epidemic in Singapore. Int J Infect Dis. 2007;11(3):263-7.

Publication Dates

  • Publication in this collection
    Oct-Dec 2014

History

  • Received
    27 July 2014
  • Accepted
    10 Oct 2014
Associação de Medicina Intensiva Brasileira - AMIB Rua Arminda, 93 - Vila Olímpia, CEP 04545-100 - São Paulo - SP - Brasil, Tel.: (11) 5089-2642 - São Paulo - SP - Brazil
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