Extracorporeal membrane oxygenation with plasma exchange in a patient with alveolar haemorrhage secondary to Wegener's granulomatosis

Barnes, Stacey; Naughton, M.; Douglass, Jo A; Murphy, Deirdre

doi:10.1111/j.1445-5994.2012.02720.x

Cited by 24 publications

(23 citation statements)

References 2 publications

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“…Furthermore, preexisting severe bleeding has been considered a contraindication 5,9,24,25. Nevertheless, good results have been reported in ECMO recipients with severe respiratory failure associated with trauma and hemorrhagic shock,24 intracranial bleeding,25 and severe pulmonary bleeding of various causes 4–11,17–22…”

Section: Discussionmentioning

confidence: 99%

“…Initial improvement and weaning from ECMO has been reported in an adult patient with Goodpasture’s-like pulmonary-renal syndrome, who subsequently died after rebleeding 36. There are at least seven case reports of VV ECMO applied to adults with acute refractory respiratory failure secondary to Wegener’s granulomatosis, most of which had severe preexisting pulmonary hemorrhage 11,18–22,37…”

Section: Discussionmentioning

confidence: 99%

“…ECMO treatment in respiratory failure associated with severe pulmonary bleeding imposes a management dilemma. Although limited, the reported experience of successful ECMO application in acute respiratory failure associated with pulmonary bleeding continues to accumulate,4–11,17–22,26–37 thus encouraging consideration of its application 39…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, it is most frequently manifested as small vessel vasculitis affecting the upper and lower respiratory tract and the kidneys. In ANCA-associated vasculitis, including GPA, alveolar hemorrhage, and concomitant glomerulonephritis causing renal insufficiency (pulmonary-renal syndrome) are associated with high mortality 5,7–11,13–22…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Successful application of extracorporeal membrane oxygenation due to pulmonary hemorrhage secondary to granulomatosis with polyangiitis

Hohenforst-Schmidt¹,

Petermann²,

Visouli³

et al. 2013

DDDT

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Extracorporeal membrane oxygenation (ECMO) is increasingly applied in adults with acute refractory respiratory failure that is deemed reversible. Bleeding is the most frequent complication during ECMO support. Severe pre-existing bleeding has been considered a contraindication to ECMO application. Nevertheless, there are cases of successful ECMO application in patients with multiple trauma and hemorrhagic shock or head trauma and intracranial hemorrhage. ECMO has proved to be life-saving in several cases of life-threatening respiratory failure associated with pulmonary hemorrhage of various causes, including granulomatosis with polyangiitis (Wegener’s disease). We successfully applied ECMO in a 65-year-old woman with acute life-threatening respiratory failure due to diffuse massive pulmonary hemorrhage secondary to granulomatosis with polyangiitis, manifested as severe pulmonary-renal syndrome. ECMO sustained life and allowed disease control, together with plasmapheresis, cyclophosphamide, corticoids, and renal replacement therapy. The patient was successfully weaned from ECMO, extubated, and discharged home. She remains alive on dialysis at 17 months follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Successful application of extracorporeal membrane oxygenation due to pulmonary hemorrhage secondary to granulomatosis with polyangiitis

Hohenforst-Schmidt¹,

Petermann²,

Visouli³

et al. 2013

DDDT

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“…Steroids are routinely used as a part of induction remission for GPA and also recommended for moderate and severe ARDS [14]. Based on case reports, extracorporeal life support (ECLS) can also be considered in selected patients with pulmonary hemorrhage [15–17]. The cautious use of anticoagulation should be balanced with the risk of bleeding.…”

Section: Discussionmentioning

confidence: 99%

Rituximab—A Drug with Many Facets and Cures: A Treatment for Acute Refractory Hypoxemic Respiratory Failure Secondary to Severe Granulomatosis with Polyangiitis

Powers

Uppalapati

Gogineni

et al. 2013

Case Reports in Critical Care

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Granulomatosis with Polyangiitis (GPA) is a rare systemic anti neutrophil cytoplasmic antibody (ANCA-) associated granulomatous vasculitis of the small and medium sized blood vessels. Diffuse alveolar hemorrhage (DAH) is a rare life-threatening complication of GPA. In our patient, cyclophosphamide was held secondary to complications of acute kidney injury, hematuria, and concern for a possible hemorrhagic cystitis. However, during the workup for hematuria the patient acutely developed respiratory failure and was found to have DAH. The patient was initially supported with mechanical ventilation volume control mode, steroids, and plasma exchange. With no improvement of oxygenation, the mode of ventilation was changed to airway pressure release ventilation (APRV) and the patient was started on rituximab. The patient clinically improved over the next few days, was able to be extubated, and was transferred out of the intensive care unit.

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Hémorragie intra-alvéolaire et syndrome pneumo-rénal

Mayaud

Parrot

Fartoukh

et al. 2013

Maladies Rares en Médecine D’urgence

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Extracorporeal membrane oxygenation with plasma exchange in a patient with alveolar haemorrhage secondary to Wegener's granulomatosis

Cited by 24 publications

References 2 publications

Successful application of extracorporeal membrane oxygenation due to pulmonary hemorrhage secondary to granulomatosis with polyangiitis

Successful application of extracorporeal membrane oxygenation due to pulmonary hemorrhage secondary to granulomatosis with polyangiitis

Rituximab—A Drug with Many Facets and Cures: A Treatment for Acute Refractory Hypoxemic Respiratory Failure Secondary to Severe Granulomatosis with Polyangiitis

Hémorragie intra-alvéolaire et syndrome pneumo-rénal

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