Extracorporeal membrane oxygenation as a bridge to liver transplantation for acute respiratory distress syndrome-induced life-threatening hypoxaemia aggravated by hepatopulmonary syndrome

Critical Care

Jean-Jacques Rouby²  François Durand⁴  Pauline Houssel⁴  Laurent Hannoun¹  Jean-Christophe Vaillant¹  Qin Lu²  Chung Hi Do²  Corinne Vézinet²  Daniel Eyraud²  Rubin Luo³  Hélène Brisson²  Hervé Mal⁵  Antoine Monsel² 

[1] Department of Hepatobiliary and Liver Graft Surgery, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, 83 Bd de l'Hôpital 75013, Paris, France;Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, UPMC Univ Paris 06, 83 Bd de l'Hôpital, 75013, Paris, France;Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, 310009, China;Department of Hepatology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Bd Gen Leclerc 92110, Clichy, France;Department of Pneumology, Hopital Bichat-Claude Bernard, Assistance Publique Hôpitaux de Paris, 46 Rue Henri Huchard 75018, Paris, France

关键词: orthotopic liver transplantation;    extracorporeal membrane oxygenation;    hypoxaemia;    hepatopulmonary syndrome;    Acute respiratory distress syndrome;   

Others  :  1093727
DOI  :  10.1186/cc10476

 received in 2011-03-10, accepted in 2011-09-29,  发布年份 2011

【 摘 要 】

Introduction

Combined with massive lung aeration loss resulting from acute respiratory distress syndrome, hepatopulmonary syndrome, a liver-induced vascular lung disorder characterized by diffuse or localized dilated pulmonary capillaries, may induce hypoxaemia and death in patients with end-stage liver disease.

Methods

The case of such a patient presenting with both disorders and in whom an extracorporeal membrane oxygenation was used is described.

Results

A 51-year-old man with a five-year history of alcoholic cirrhosis was admitted for acute respiratory failure, platypnoea and severe hypoxaemia requiring emergency tracheal intubation. Following mechanical ventilation, hypoxaemia remained refractory to positive end-expiratory pressure, 100% of inspired oxygen and inhaled nitric oxide. Two-dimensional contrast-enhanced (agitated saline) transthoracic echocardiography disclosed a massive right-to-left extracardiac shunt, without patent foramen ovale. Contrast computed tomography (CT) of the thorax using quantitative analysis and colour encoding system established the diagnosis of acute respiratory distress syndrome aggravated by hepatopulmonary syndrome. According to the severity of the respiratory condition, a veno-venous extracorporeal membrane oxygenation was implemented and the patient was listed for emergency liver transplantation. Orthotopic liver transplantation was performed at Day 13. At the end of the surgical procedure, the improvement in oxygenation allowed removal of extracorporeal membrane oxygenation (Day 5). The patient was discharged from hospital at Day 48. Three months after hospital discharge, the patient recovered a correct physical autonomy status without supplemental O₂.

Conclusions

In a cirrhotic patient, acute respiratory distress syndrome was aggravated by hepatopulmonary syndrome causing life-threatening hypoxaemia not controlled by standard supportive measures. The use of extracorporeal membrane oxygenation, by controlling gas exchange, allowed the performing of a successful liver transplantation and final recovery.

【 授权许可】

   
2011 Monsel et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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