【体外膜肺ECMO精品课件】 How to performed dialysis circuit with ECMO.ppt

How to performed dialysis circuit with ECMO 1996-2010 ECMO + Dialysis data Survival rate MCS (307/73) 23.8% Septic shock (14/3) 21.4% ARDS (72/22) 30.5% LTx (7/0) 0.00% 24.5% ECMO Data base：900 / 400 ( 44.4% ) Outline Case presentation Critical dialysis in ECMO patients Data report Case Presentation 林 x x Chart NO:4462271 NTUH Admission date:2011-5-14 SICU Admission date:2011-5-14 Severe septic shock with ARDS Expired date:2011-6-13 Total SICU stay :30 days Patient history This 44 yrs man had no systemic disease before. Suffered general malaise and joint pain (3月) ? 中山醫學院附設醫院：with bilateral dorsal hands swelling, local heat and pain were found. ? visited 中國 hospital where lab data showed rheumatic factor 400. Rheumatoid arthritis was diagnosed. Patient Course Symmetric polyarthitis of hands was found. Body weight loss 6kg in one month. Under the impression of acute RA, he was admitted and systemic steroid and Mabthera infusion. MTX (Methotrexate 4# Q7D) was also added. The symptoms of RA improved after treatment. ? Discharge Patient Course 4/28 ER Shortness of breath, dry cough were noted. CXR showed diffuse bilateral alveolar infiltration. Hypoxia was noted. Chest CT showed diffuse peribronchial parenchyma and alveolar inflammatory change. Acute lung injury was impressed. 4/30 Admitted to MICU Patient Course BiPAP and relative clear bilateral breathing sound and scanty sputum was noted. Tazocin was given (2011/04/30~2011/05/04). Tamiflu 75mg for 5 days (2011/04/30~2011/05/04). Hydrocortisone 100mg Q8H for RA and ARDS. 5/4 Intubated ?SpO2 90%, FiO2：0.9, PEEP15,TV 600ml. Gancyclovir 500mg Q12h for possible CMV infection. 5/5 IVIG. Antibiotics were then shifted to Vancomycin and Tienam. Diflucan. SLEDD-f on ECMO Early goal-directed hemofiltration therapy Pulse high volume therapy：96hr 1. 100 cc/Kg/hr X 4hr, then 50cc/Kg/hr X 92hr 2. Simultaneous APC (Xigirs) therapy 1+2 keep 96hr 5/18 CAVH on ECMO：2000 cc//hr Treatment Course 5/18 Xigr