Nanomembrane-Based Therapeutic Plasmapheresis after Non-Invasive Ventilation Failure for Treatment of a Patient with Acute Respiratory Distress Syndrome and Myasthenia Gravis: A Case Report

Abstract

Acute respiratory distress syndrome (ARDS) is characterized by a widespread inflammation of the lungs, causing severe hypoxemia. Several mediators have been associated with it and almost all of them are small enough to be filtrated through a nanomembrane. We present a case report of a 41-year-old man with myasthenia gravis in remission; he developed ARDS caused by pneumonia. Although he performed well on both non-invasive and invasive mechanical ventilation, his oxygenation continued to deteriorate. As a last resort of treatment, we decided to apply nanomembrane-based apheresis to cleanse his plasma from the harmful inflammatory mediators. After 3 sessions of plasmapheresis, his condition improved and he was successfully weaned from mechanical ventilation. The obtained results gave us ground to assume that the removal of bioactive molecules can be a useful adjunct to protective mechanical ventilation in ARDS.

Therapeutic Plasma Exchange: A potential Management Strategy for Critically Ill COVID-19 Patients

“…42 In another study, TPE was used to treat ARDS in a 41-year-old man with a history of myasthenia gravis in remission, who had developed ARDS secondary to pneumonia. 43 When his oxygenation continued to deteriorate despite invasive mechanical ventilation, nanomembrane-based apheresis was employed, and after 3 sessions, the patient was successfully weaned off the ventilator. 43 Another condition where TPE has been used successfully in reducing markedly elevated cytokines is IVIG-resistant Kawasaki disease (KD), a vasculitic, coagulopathic condition associated with coronary artery aneurysms and myocardial ischemia.…”

“…43 When his oxygenation continued to deteriorate despite invasive mechanical ventilation, nanomembrane-based apheresis was employed, and after 3 sessions, the patient was successfully weaned off the ventilator. 43 Another condition where TPE has been used successfully in reducing markedly elevated cytokines is IVIG-resistant Kawasaki disease (KD), a vasculitic, coagulopathic condition associated with coronary artery aneurysms and myocardial ischemia. [44][45][46][47][48][49] Elevated inflammatory cytokines including TNF-a, IL-1b, IL-6, IL-8, and IFN-g have been reported in the acute phase of KD.…”

“… 42 In another study, TPE was used to treat ARDS in a 41-year-old man with a history of myasthenia gravis in remission, who had developed ARDS secondary to pneumonia. 43 When his oxygenation continued to deteriorate despite invasive mechanical ventilation, nanomembrane-based apheresis was employed, and after 3 sessions, the patient was successfully weaned off the ventilator. 43 …”

“… 43 When his oxygenation continued to deteriorate despite invasive mechanical ventilation, nanomembrane-based apheresis was employed, and after 3 sessions, the patient was successfully weaned off the ventilator. 43 …”

Non-Invasive Ventilation in a Non-Standard Setting – Is it Safe to Ventilate Outside the ICU?

“…and acute hypoxemic respiratory failure, the experts do not give any recommendation, nor is there strong evidence to support it. NIV has been also used for respiratory support in neuromuscular disorders [3,4], kyphoscoliosis [5] and obesity hypoventilation syndrome [6].…”