Extracorporeal Membrane Oxygenation in a Patient With Refractory Acute Respiratory Distress Syndrome Secondary to Toxic Epidermal Necrolysis

Toxic epidermal necrolysis (TEN) is a rare condition affecting an estimated 1 to 2 cases per million per year, with reported mortality between 30% and 50% typically because of multiorgan failure or sepsis. Acute pulmonary complications from this disorder include bronchial mucosal sloughing, pulmonar...

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Bibliographic Details
Main Authors: Sine, Christy R, Chung, Kevin K, Pamplin, Jeremy C, Batchinsky, Andriy I, Hull, James E, King, Booker T, Derdak, Stephen, Walker, Josh, McNeil, Jeffrey D, Renz, Evan M, Cannon, Jeremy W
Format: Report
Language:English
Subjects:
ADULTS
Anatomy and Physiology
ANTICOAGULANTS
ARDS(ACUTE RESPIRATORY DISTRESS SYNDROME)
BACTERIAL PNEUMONIA
CASE STUDIES
CLINICAL MEDICINE
ECLS(EXTRACORPOREAL LIFE SUPPORT)
INTUBATION
Life Support Systems
LUNG
Medicine and Medical Research
MORTALITY RATE
MUCOUS MEMBRANES
PHYSIOLOGICAL EFFECTS
PULMONARY EDEMA
RESPIRATORY DISEASES
SEPSIS
SIGNS AND SYMPTOMS
SKIN DISEASES
SURVIVABILITY
TEN(TOXIC EPIDERMAL NECROLYSIS)
TRAUMA
VENTILATORS
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Description
Summary:Toxic epidermal necrolysis (TEN) is a rare condition affecting an estimated 1 to 2 cases per million per year, with reported mortality between 30% and 50% typically because of multiorgan failure or sepsis. Acute pulmonary complications from this disorder include bronchial mucosal sloughing, pulmonary edema, and infectious pneumonitis. Pulmonary complications in TEN occurred in 46% of patients in one series. Use of extracorporeal life support (ECLS) in adults with acute respiratory distress syndrome (ARDS) has increased markedly during the past few years after successful treatment in adults with swine flu (H1N1) and publication of the CESAR (conventional ventilation or ECMO for severe adult respiratory failure) trial, which demonstrated a lower mortality and disability at 6 months for patients referred to an ECLS center. The suggested ideal candidate for ECLS would be one with an acute, reversible, survivable illness if not for associated ARDS, no significant comorbidities, no contraindication to systemic anticoagulation, less than 8 days on mechanical ventilation, and younger than 65 years of age. Published in the Journal of Burn Care & Research, v35 n6 pE428-E430, November/December 2014.