Épuration extracorporelle du CO2 pour suppléance d’une pneumonie organisée sévère

Abstract

Acute lung injuries are usually found in intensive care unit. The diffuse alveolar damage (DAD) is the associated histological pattern and the most severe end-stage of the disease. Organizing pneumonia (OP), for which corticosteroids are the reference therapy, can mimic DAD. While postponing the response to treatment, to limit mechanical ventilation side effects, extracorporeal membrane oxygene can be proposed. We present a case of a severe OP for which extracorporeal CO2 removal (ECCO2R) is used as a bridge to recovery under corticosteroid therapy. In the context of a flu-like syndrome, the non-recovery of a lung impairment is reported to a severe OP. ECCO2R is applied when using an ultraprotective ventilation and while waiting for lung healing under corticosteroid. This strategy allowed successful recovery, early physical therapy and active mobilization. This observation presents the diagnostic and therapeutic difficulties of the lung parenchymental disease in intensive care. OP must be recognized. ECCO2R can be used in severe OP as a bridge to recovery while waiting for the corticosteroid efficacy.