Prolonged extracorporeal life support (ECLS) for varicella pneumonia

Abstract

Early recognition of imminent pulmonary failure and rapid institution of ECLS are critical in the successful management of severe, life-threatening varicella pneumonia.

Nitric oxide in the treatment of fulminant pulmonary failure in a young pregnant woman with varicella pneumonia

“…Fulminant pulmonary failure is a severe complication of varicella pneumonia with a high mortality rate. ECMO has successfully been applied for this condition [ 3,4,7] and rapid institution of ECMO is recommended for life‐threatening varicella pneumonia [ 4].…”

“…In a recent review of ARDS in pregnancy [ 6], NO is not at all considered as a therapeutic option to improve oxygenation. The decision to try NO in the present case was made in the knowledge that ECMO treatment in pregnancy is associated with poor outcome for the foetus [ 3,4], and the combination of spontaneous delivery and the anticoagulation with heparin may lead to serious bleeding complications. In view of preterm uterine contractions, we estimated the risk of spontaneous delivery to be high.…”

“…Varicella pneumonia can rapidly progress to fulminant pulmonary failure, requiring positive pressure mechanical ventilation, and, in some cases, extracorporeal membrane oxygenation (ECMO). Two cases of ECMO treatment for varicella pneumonia in pregnancy have previously been reported [ 3,4], one of which survived, but with bad outcome for the fetus. Fetal viability during ECMO seems to be poor resulting in either therapeutic or spontaneous abortion in most cases [ 3,4].…”

“…Two cases of ECMO treatment for varicella pneumonia in pregnancy have previously been reported [ 3,4], one of which survived, but with bad outcome for the fetus. Fetal viability during ECMO seems to be poor resulting in either therapeutic or spontaneous abortion in most cases [ 3,4]. The present case is to our knowledge the first report on treatment with nitric oxide (NO) to improve oxygenation in a pregnant woman with fulminant pulmonary failure due to varicella pneumonia, and with a successful outcome for both the mother and the fetus.…”

Chickenpox pneumonia: case report and literature review.

“…The largest series of ECLS in varicella pneumonia in the literature reported just seven patients, all with critical repiratory failure not responding to conventional ventilation, of whom five survived to discharge. 20 Early tracheostomy (within seven days after intubation) has been shown by some authors to be beneficial in patients ventilated for respiratory failure,2" while others have failed to demonstrate any advantage.22 There are practical reasons for early tracheostomy in patients referred for ECMO since the procedure may be more difficult in the presence of anticoagulation.…”