Successful rescue combination of extracorporeal membrane oxygenation, high-frequency oscillatory ventilation and prone positioning for the management of severe methicillin-resistant Staphylococcus aureus pneumonia complicated by pneumothorax: a case report and literature review

Hangyong He,Rui Wang,Xiao Tang,Xuyan Li,Zhaohui Tong,Hao Wang,Bing Sun

doi:10.1186/s12890-017-0445-z

Hangyong He, Rui Wang + Show 5 more

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https://doi.org/10.1186/s12890-017-0445-z

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Abstract

BackgroundTo describe the experience of combination therapy with extracorporeal membrane oxygenation(ECMO), high-frequency oscillatory ventilation(HFOV) and prone positioning in treating severe respiratory failure caused by community acquired methicillin resistant Staphylococcus aureus(CA-MRSA).Case presentationA 30-year-old female presented with fever and dyspnea for 3 days. She was diagnosed CA-MRSA pneumonia complicated by severe respiratory failure, pneumothorax and neutropenia. Venovenous ECMO was applied within 8 h of the pneumothorax diagnosis. For amelioration of ventilator-induced lung injury, HFOV and prone positioning were combined with ECMO. The patient’s condition improved considerably. ECMO was weaned on day 19, and she was discharged on day 48 with good lung recovery.ConclusionsTo the best of our knowledge, this was the first case in which ECMO was combined with HFOV and prone positioning to treat severe necrotic CA-MRSA pneumonia complicated with pneumothorax. This combination therapy may provide safe respiratory support, may minimize the risk of barotrauma, and provide better drainage of secretions in patients with necrotizing pneumonia.

Highlights

To describe the experience of combination therapy with extracorporeal membrane oxygenation(ECMO), high-frequency oscillatory ventilation(HFOV) and prone positioning in treating severe respiratory failure caused by community acquired methicillin resistant Staphylococcus aureus(CA-MRSA).Case presentation: A 30-year-old female presented with fever and dyspnea for 3 days
To the best of our knowledge, this was the first case in which ECMO was combined with HFOV and prone positioning to treat severe necrotic Communityacquired methicillin-resistant S. aureus (CA-MRSA) pneumonia complicated with pneumothorax
When patients are supported with ECMO and safe oxygenation is reached, HFOV may help re-open the collapsed lung and prone positioning may provide good drainage of necrotic secretions in the lung, which together may lead to rapid recovery and prevent or help heal the pneumothoraces

Summary

Conclusions

To the best of our knowledge, this was the first case in which ECMO was combined with HFOV and prone positioning to treat severe necrotic CA-MRSA pneumonia complicated with pneumothorax.

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