1
|
Martin AK, Shah SZ, Guru PK, Chaudhary S, Franco PM, Makey I, Fritz AV, Pham SM, Thomas M. Multidisciplinary Approach for Lung Transplantation due to COVID-19. Mayo Clin Proc Innov Qual Outcomes 2022; 6:200-208. [PMID: 35281693 PMCID: PMC8904149 DOI: 10.1016/j.mayocpiqo.2022.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), a novel etiology of end-stage lung disease, has resulted in major disruptions to the process of health care delivery worldwide. These disruptions have led to team-based innovations globally, resulting in a broad range of new processes in cardiopulmonary perioperative management. A key intersection of multidisciplinary teamwork and COVID-19 is found in lung transplantation, in which diverse teams collaborate throughout the perioperative period to achieve optimal outcomes. In this article, we describe the multidisciplinary approach taken by Mayo clinic in Florida to manage patients with COVID-19 presenting for lung transplantation.
Collapse
Key Words
- ARDS, acute respiratory distress syndrome
- CAD, coronary artery disease
- COVID-19, coronavirus disease 2019
- ECMO, extracorporeal membrane oxygenation
- ESLD, end-stage lung disease
- ICU, intensive care unit
- MCF, Mayo clinic in Florida
- MDT, multidisciplinary team
- OR, operating room
- PCR, polymerase chain reaction
- POD, postoperative day
- PPE, personal protective equipment
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- VA, veno-arterial
- VV, veno-venous
Collapse
Affiliation(s)
- Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic in Florida, Jacksonville, FL
| | - Sadia Z Shah
- Department of Transplantation, Mayo Clinic in Florida, Jacksonville, FL
| | - Pramod K Guru
- Department of Critical Care, Mayo Clinic in Florida, Jacksonville, FL
| | - Sanjay Chaudhary
- Department of Critical Care, Mayo Clinic in Florida, Jacksonville, FL
| | | | - Ian Makey
- Department of Cardiothoracic Surgery, Mayo Clinic in Florida, Jacksonville, FL
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic in Florida, Jacksonville, FL
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic in Florida, Jacksonville, FL
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic in Florida, Jacksonville, FL
| |
Collapse
|
2
|
Choudhary M, Chen Y, Friedman O, Cuk N, Ben-Shlomo A. Pheochromocytoma Crisis Presenting With ARDS Successfully Treated With ECMO-Assisted Adrenalectomy. AACE Clin Case Rep 2021; 7:310-314. [PMID: 34522771 PMCID: PMC8426613 DOI: 10.1016/j.aace.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 01/19/2023] Open
Abstract
Objective Pheochromocytoma (PCC) crisis caused by acute catecholamine release from an adrenal PCC or extra-adrenal paraganglioma can be difficult to diagnose and may require an unconventional management strategy to achieve good outcomes. We describe a case of PCC crisis presenting with acute respiratory distress syndrome (ARDS) that resolved with stabilization on veno-venous (VV) extracorporeal membrane oxygenation (ECMO) during adrenalectomy. Case Description A 30-year-old man with a history of severe alcohol use disorder and a prior hospital admission for alcohol withdrawal syndrome presented with sudden-onset hemoptysis, altered mental status, and severe dyspnea that rapidly deteriorated to ARDS requiring ECMO support. He demonstrated hemodynamic collapse after cannulation for VV-ECMO and stabilized after conversion to veno-arterial-ECMO, but ARDS persisted and he developed acute renal failure. Computed tomography without contrast done as part of work-up for a presumed infection revealed a 6.9 × 6.4 cm right adrenal mass suspicious for pheochromocytoma. Plasma and random urine metanephrine levels were markedly elevated. ARDS persisted despite α- and β-adrenoreceptor blockade, and he underwent laparoscopic right adrenalectomy with VV-ECMO support. Pathology confirmed PCC with intermediate risk for malignancy. Postoperatively, he was weaned off respiratory and renal support within 10 days, showed rapid clinical improvement, and was discharged 1 month later. Conclusion This case highlights diagnostic and management challenges associated with patients with PCC crisis presenting with ARDS. A multidisciplinary team approach is critical to identifying appropriate treatment strategies.
Collapse
Affiliation(s)
- Manita Choudhary
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yufei Chen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Oren Friedman
- Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Natasha Cuk
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Anat Ben-Shlomo
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| |
Collapse
|
3
|
Zern EK, Ramirez PR, Rubin J, Rosenfield K, Manning P, Raz Y, Funamoto M, D'Alessandro D, Crowley JC, Shelton K. Severe Tricuspid Valve Endocarditis: A Tale of 2 Circuits. JACC Case Rep 2021; 3:1343-1349. [PMID: 34505066 PMCID: PMC8414435 DOI: 10.1016/j.jaccas.2021.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 10/31/2022]
Abstract
A 25-year-old woman with severe tricuspid valve endocarditis and septic pulmonary emboli required VA-ECMO for recurrent hypoxemia-induced cardiac arrest. We present the clinical challenges requiring ECMO circuit reconfiguration and a percutaneous approach for vegetation debulking. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Emily K Zern
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paolo R Ramirez
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Jonah Rubin
- Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenneth Rosenfield
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Patrick Manning
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yuval Raz
- Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Masaki Funamoto
- Cardiac Surgery Division, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David D'Alessandro
- Cardiac Surgery Division, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jerome C Crowley
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenneth Shelton
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Aokage T, Tsukahara K, Fukuda Y, Tokioka F, Taniguchi A, Naito H, Nakao A. Heat-not-burn cigarettes induce fulminant acute eosinophilic pneumonia requiring extracorporeal membrane oxygenation. Respir Med Case Rep 2018; 26:87-90. [PMID: 30560050 PMCID: PMC6288977 DOI: 10.1016/j.rmcr.2018.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/30/2018] [Accepted: 12/02/2018] [Indexed: 12/12/2022] Open
Abstract
Background Although the cause of acute eosinophilic pneumonia (AEP) has not yet been fully clarified, cigarette smoking is reported to be a risk factor for developing AEP. The heat-not-burn cigarette (HNBC) was developed to reduce the adverse effects of smoke on the user's surroundings. However, the health risks associated with HNBCs have not yet been clarified. We report a successfully treated case of fatal AEP presumably induced by HNBC use. Presentation of case A 16-year-old man commenced HNBC smoking two weeks before admission and subsequently suffered from shortness of breath that gradually worsened. The patient was transferred to emergency department and immediately intubated because of respiratory failure. Computed tomography showed mosaic ground-glass shadows on the distal side of both lungs with a PaO2/FIO2 ratio of 76. The patient required veno-venous extracorporeal membrane oxygenation (ECMO) for severe respiratory failure. He was diagnosed with AEP by clinical course and detection of eosinophils in sputum; thus, methylprednisolone was administrated. The patient was weaned off ECMO four days after initiation and extubated the day after. He fully recovered without sequelae. Conclusion As far as we know, our patient is the first case of AEP induced by HNBC use successfully treated with ECMO. Emergency physicians must be aware that HNBCs can induce fatal AEP. The use of heat-not-burn cigarettes has been increasing in recent years. The effects of heat-not-burn cigarettes on health have not yet been clarified. Heat-not-burn cigarettes possibly induce acute eosinophilic pneumonia. Extracorporeal membrane oxygenation was effective in a patient with a severe case of acute eosinophilic pneumonia.
Collapse
Key Words
- AEP, acute eosinophilic pneumonia
- Acute eosinophilic pneumonia
- BAL, bronchoalveolar lavage
- CT, computed tomography
- Cigarettes
- ECMO
- ECMO, extracorporeal membrane oxygenation
- Extracorporeal membrane oxygenation
- FIO2, fraction of inspiratory oxygen
- HNBC, heat-not-burn cigarette
- Heat-not-burn cigarettes
- IV, intravenous administration
- PEEP, positive end-expiratory pressure
- PSL, prednisolone
- PaO2, partial pressure of arterial oxygen
- Pplat, plateau pressure
- SpO2, oxygen saturation of pulse oximetry
- Tobacco
- VV, veno-venous
- mPSL, methylprednisolone
Collapse
Affiliation(s)
- Toshiyuki Aokage
- Department of Geriatric Emergency Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Corresponding author. Department of Geriatric Emergency Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Kohei Tsukahara
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasushi Fukuda
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Fumiaki Tokioka
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Akihiko Taniguchi
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|