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Massive airway hemorrhage in severe COVID-19 and the role endotracheal tube clamping (preprint)
researchsquare; 2022.
Preprint
Dans Anglais
| PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2393880.v1
ABSTRACT
Background Venovenous extracorporeal membrane oxygenation (VV-ECMO) has been widely used in treating patients with coronavirus disease 2019 (COVID-19) with severe respiratory failure. However, there are few reports of the successful treatment of patients with massive airway hemorrhage in severe COVID-19 during VV-ECMO treatment.Methods We analyzed the treatment process of a patient with massive airway hemorrhage in severe COVID-19, who underwent prolonged VV-ECMO treatment.Results A 59-year-old female patient was admitted to the intensive care unit after confirmed severe acute respiratory syndrome coronavirus 2 infection with severe acute respiratory distress syndrome. VV-ECMO, mechanical ventilation and prone ventilation were administered. Major airway hemorrhage occurred on day 14 of ECMO treatment; conventional management was ineffective. We provided complete VV-ECMO support, discontinued anticoagulation, disconnected the ventilator, clipped the tracheal intubation, and intervened to embolize the descending bronchial arteries. After the pulmonary pemorrhage stopped, we administered cryotherapy under bronchoscopy, low-dose urokinase locally, and bronchoalveolar lavage in the airway to clear the blood clots. The patient’s condition gradually improved; she underwent ECMO weaning and decannulation after 88 days of VV-ECMO treatment, and the membrane oxygenator was changed out four times. She was successfully discharged after 182 days in hospital.Conclusion Massive airway hemorrhage in patients with severe COVID-19 and treated with ECMO is catastrophic. It is feasible to clamp the tracheal tube with the full support of ECMO. Notably, bronchoscopy with cryotherapy is effective for removing blood clots.
Texte intégral:
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Collection:
Preprints
Base de données:
PREPRINT-RESEARCHSQUARE
Sujet Principal:
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Insuffisance respiratoire
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Infections à coronavirus
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COVID-19
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Hémorragie
langue:
Anglais
Année:
2022
Type de document:
Preprint
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