Abstract
We report the case of a patient with severe respiratory failure as a result of pneumonia caused by influenza virus that was managed with extracorporeal membrane oxygenation (ECMO). We performed fluid control with continuous hemodiafiltration (CHDF) to manage extravascular lung water (EVLW) and pulmonary vascular permeability index (PVPI). A 50-year-old man with severe respiratory failure was transferred to our hospital after failure of treatment with conventional ventilator management. ECMO was introduced immediately because highly diffuse infiltration shadows were observed on the chest X-ray and PaO2/FiO2 was significantly decreased (79.3). We detected influenza A/H1N1pdm09 in his bronchial lavage fluid and administered intravenous peramivir. A transpulmonary thermodilution monitoring system showed EVLW of 32 mL/kg and PVPI of 6.7; on the basis of these parameters, we diagnosed severe lung edema with marked pulmonary hyperpermeability. As a result of daily fluid removal by CHDF with EVLW and PVPI monitoring, lung permeability and oxygenation gradually improved. ECMO was discontinued on the 39th day of hospitalization, and the patient was discharged from the hospital on the 96th day. Management of long-term ECMO and strict body fluid control by CHDF were effective in improving the severe pulmonary lesions. EVLW and PVPI were suggested as parameters to determine the necessary fluid removal volume, even in ECMO setting.
