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

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

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

Monseletal.CriticalCare2011,15:R234 /content/15/5/R234 RESEARCH OpenAccess Extracorporealmembraneoxygenationasa bridgetolivertransplantationforacute respiratorydistresssyndrome-inducedlife- threateninghypoxaemiaaggravatedby hepatopulmonarysyndrome AntoineMonsel1,HervéMal2*,HélèneBrisson1,RubinLuo1,5,DanielEyraud1,CorinneVézinet1,ChungHiDo1, QinLu1,Jean-ChristopheVaillant3,LaurentHannoun3,PaulineHoussel4,Fran?oisDurand4and Jean-JacquesRouby1* Abstract Introduction:Combinedwithmassivelungaerationlossresultingfromacuterespiratorydistresssyndrome, hepatopulmonarysyndrome,aliver-inducedvascularlungdisordercharacterizedbydiffuseorlocalizeddilated pulmonarycapillaries,mayinducehypoxaemiaanddeathinpatientswithend-stageliverdisease. Methods:Thecaseofsuchapatientpresentingwithbothdisordersandinwhomanextracorporealmembrane oxygenationwasusedisdescribed. Results:A51-year-oldmanwithafive-yearhistoryofalcoholiccirrhosiswasadmittedforacuterespiratoryfailure, platypnoeaandseverehypoxaemiarequiringemergencytrachealintubation.Followingmechanicalventilation, hypoxaemiaremainedrefractorytopositiveend-expiratorypressure,100%ofinspiredoxygenandinhalednitric oxide.Two-dimensionalcontrast-enhanced(agitatedsaline)transthoracicechocardiographydisclosedamassive right-to-leftextracardiacshunt,withoutpatentforamenovale.Contrastcomputedtomography(CT)ofthethorax usingquantitativeanalysisandcolourencodingsystemestablishedthediagnosisofacuterespiratorydistress syndromeaggravatedbyhepatopulmonarysyndrome.Accordingtotheseverityoftherespiratorycondition,a veno-venousextracorporealmembraneoxygenationwasimplementedandthepatientwaslistedforemergency livertransplantation.OrthotopiclivertransplantationwasperformedatDay13.Attheendofthesurgical procedure,theimprovementinoxygenationallowedremovalofextracorporealmembraneoxygenation(Day5). ThepatientwasdischargedfromhospitalatDay48.Threemonthsafterhospitaldischarge,thepatientrecovereda correctphysicalautonomystatuswithoutsupplementalO2. Conclusions:Inacirrhot