Veno-venous extracorporeal membrane oxygenation (ECMO) for acute respiratory failure caused by liver abscess

Abstract

Liver abscess remains a life-threatening disease, particularly when it results in systemic organ failure necessitating intensive care. Only few cases of respiratory failure caused by liver abscess and treated with veno-venous extracorporeal membrane oxygenation (ECMO) have been reported. Here we present a case of liver abscess with rapid progression of multiple organ dysfunction, including severe acute respiratory failure on admission to the intensive care unit (ICU). Upon admission, we immediately initiated artificial organ support systems, including ventilator, continuous renal replacement therapy, and cardiovascular drug infusion for septic multiple organ failure and source control. Despite this initial management, respiratory failure deteriorated and V-V ECMO was introduced. The case developed abdominal compartment syndrome, for which we performed a bedside decompressive laparotomy in the ICU. The case gradually recovered from multiple organ failure and was discharged from the ICU on day 22 and from the hospital on day 53. Since liver abscess is potentially lethal and respiratory failure on admission is an additional risk factor of mortality, V-V ECMO may serve as an adjunctive choice of artificial organ support for cases of severe acute respiratory failure caused by liver abscess.

Perioperative Management of the Adult Patient on Venovenous Extracorporeal Membrane Oxygenation Requiring Noncardiac Surgery

“…14 Abdominal compartment syndrome, which is associated with high mortality, may be caused by resuscitative fluid shifts and/or pathophysiology related to the patient's underlying critical illness. 91,92 The condition is most common in pediatrics and neonates who are highly sensitive to the increased in circulating volume introduced by the ECMO circuit. 91,92 In addition to causing abdominal organ dysfunction and reducing pulmonary compliance, ECMO flows are often reduced in abdominal compartment syndrome due to the decrease in venous return, necessitating decompressive laparotomy.…”

“…91,92 The condition is most common in pediatrics and neonates who are highly sensitive to the increased in circulating volume introduced by the ECMO circuit. 91,92 In addition to causing abdominal organ dysfunction and reducing pulmonary compliance, ECMO flows are often reduced in abdominal compartment syndrome due to the decrease in venous return, necessitating decompressive laparotomy. 91,92 Laparoscopic surgery, which utilizes carbon dioxide to insufflate the abdomen, causes systemic absorption of the gas, which challenges the decarboxylation abilities of the membrane lung, resulting in refractory respiratory acidosis VV ECMO patients.…”

“…91,92 In addition to causing abdominal organ dysfunction and reducing pulmonary compliance, ECMO flows are often reduced in abdominal compartment syndrome due to the decrease in venous return, necessitating decompressive laparotomy. 91,92 Laparoscopic surgery, which utilizes carbon dioxide to insufflate the abdomen, causes systemic absorption of the gas, which challenges the decarboxylation abilities of the membrane lung, resulting in refractory respiratory acidosis VV ECMO patients. Although laparoscopy is generally discouraged, preemptively increasing sweep gas flow is advisable to prevent an acute decrease in pH upon insufflation and to manage the increased dioxide load.…”