RESUMEN
The purpose of this review is to examine the indications of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS). This technique of oxygenation has significantly increased worldwide with the H1N1 flu pandemic. The goal of ECMO is to maintain a safe level of oxygenation and controlled respiratory acidosis under protective ventilation. The enthusiasm for ECMO should not obscure the consideration for potential associated complications. Before widespread diffusion of ECMO, new trials should test the efficacy of early initiation or CO2 removal in addition to, or even as an alternative to mechanical ventilation for severe ARDS.
Asunto(s)
Oxigenación por Membrana Extracorpórea/métodos , Síndrome de Dificultad Respiratoria/terapia , Adulto , Dióxido de Carbono/sangre , Dióxido de Carbono/aislamiento & purificación , Humanos , Hipercapnia/terapia , Oxígeno/administración & dosificación , Oxígeno/uso terapéuticoRESUMEN
INTRODUCTION: The platypnea-orthodeoxia syndrome (PO) includes: (i) a dyspnea increasing with orthostatism and decreasing in supine position, (ii) wide positional range in arterial oxygen saturation with tachycardia, (iii) and hypoxemia refractory to oxygen therapy. This syndrome is usually related to a cardiac right-left shunt, and rarely to a pulmonary shunt. OBSERVATION: We report a case of a patient presenting with a post-lung infection dyspnea associated with severe hypoxemia and shunt effect at blood gas. Contrast-enhanced CT-scan showed no pulmonary embolism. PO syndrome was suspected given the transcutaneous blood oxygen saturation variation from 90% in supine position to 60% in standing position, tachycardia, and absence of response to the intensive oxygen therapy. CONCLUSION: This syndrome should be known by physicians as a possible differential diagnose for refractory dyspnea to oxygen since effective treatment is available.