Acute respiratory distress syndrome due to severe pulmonary tuberculosis treated with extracorporeal membrane oxygenation: A case report and review of the literature

Abstract

Mortality in patients with pulmonary tuberculosis remains high, especially in those who develop acute respiratory distress syndrome (ARDS). We report on a-48-year-old man with ARDS due to severe pulmonary tuberculosis who was rescued by extracorporeal membrane oxygenation (ECMO). He was initially hospitalized in the intensive care unit and noninvasive positive-pressure ventilation started. He was also administered anti-tuberculosis drugs and received systemic corticosteroid therapy. Six days later, further deterioration of gas exchange prompted the decision to intubate. However, he experienced progressive deterioration of arterial oxygenation despite conventional ventilatory support. We therefore decided to administer ECMO on day 9. After initiation of these treatments and ECMO support, pulmonary infiltrate and oxygenation status gradually improved and ECMO was discontinued on day 52. The patient was finally discharged from our hospital without severe disability. ECMO should be considered one of the treatment options for the management of ARDS due to severe pulmonary tuberculosis.

Miliary tuberculosis leading to acute respiratory distress syndrome: Clinical experience in pediatric intensive care

“…However, several reports suggest their usefulness in the management of miliary TB with or without meningeal involvement . Finally, until now, there are few reports of extracorporeal support use in TB‐associated ARDS, due to the slow healing process characterizing severe pulmonary TB …”

“…19 Finally, until now, there are few reports of extracorporeal support use in TB-associated ARDS, due to the slow healing process characterizing severe pulmonary TB. 20 The coexistence of severe ARDS complicating miliary TB in pediatric patients makes our case series almost unique and really challenging for pediatric intensivists. Actually, a few retrospective studies, all carried out in eastern countries, 3,11,12 have outlined the clinical characteristics and outcome of adult patients with ARDS caused by miliary TB; recently, a systematic review of critically ill adult patients with TB disease, including miliary ARDS, has been published.…”

Behandlung von Tuberkulose auf der Intensivstation

“…In Einzelfällen des ARDS ist eine ausreichende Sicherstellung der Oxygenierung und Entfernung des Kohlendioxids durch invasive Beatmung nicht möglich. Einzelfallbeschreibungen haben den erfolgreichen Einsatz von extrakorporalen Verfahren wie ECMO (extrakorporale Membranoxygenierung) in dieser Situation beschrieben, mit teilweise langen ECMO-Zeiten von bis zu 43 Tagen [24].…”

ARDS from miliary tuberculosis successfully treated with ECMO

“…Mortality rates for patients with tuberculosis who require mechanical ventilation are high (60–70%) [[3], [4], [5]], higher than for any other cause of ARDS [1]. Experience with the use of extracorporeal membrane oxygenation (ECMO) in this setting is limited, with only a handful of case-reports published [6]. We present a case of miliary tuberculosis where prolonged ECMO therapy was successful but both diagnosis and treatment of the infection challenging.…”