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Abstract: We reported the case of a young adult with a Lemierre syndrome, which was complicated by septic shock and ARDS. Because of rapid onset of a life-threatening hypoxemia (PaO2/FiO2 =60) in the course of the ARDS despite mechanical ventilation, ECMO was started with jugular and femoral cannulas, as rescue therapy. Good control of hypoxemia was obtained and ECMO was set up for six days. No significant complication was observed. The course was nevertheless complicated by acute renal failure and a pleural fistula that necessitated separate-lung ventilation during 24hours. After 48days left in the ICU, the patient was sent to a rehabilitation unit. [Copyright &y& Elsevier]

Abstract: Objectives: High-flow nasal oxygen (Optiflow™) is validated in paediatric intensive care but not in adults’ patients for severe hypoxemia. The aim of this study was to evaluate this oxygen system delivery in adults’ patients for postoperative hypoxemia after cardiac surgery. Study design: Prospective, open study for evaluation of medical practice. Patients and methods: Patients operated upon for cardiac surgery with immediate postoperative hypoxemia characterized by SpO2 <0.96 with 50% oxygen with a Venturi mask were treated with the high-flow nasal oxygen system (O group) when it was available or with the classical high-flow oxygen face mask (M group). Gas exchanges were measured at the end of the surgery, at the beginning of the treatment and 1 hour, 6 hours after the inclusion and at day 1 and 2 post-treatment. Parameters studied were: duration of hypoxemia, duration of ICU stay, postoperative pneumonia occurrence, requirement of re-intubation, non invasive ventilation and catecholamine. Tolerance was evaluated with measurement of pain (visual scale), satisfaction (visual scale), and dryness of mouth. Results: Forty patients were included, 19 in group O, 21 in group M. Patient''s characteristics did not differ between the two groups before treatment. There were no significant differences between groups for duration of hypoxemia (3.8±2.2 days in O group versus 4.3±2.3 days in M group), duration of hypoxemia, duration of ICU stay, postoperative pneumonia occurrence, requirement of re-intubation, non invasive ventilation and catecholamine. Pain was not significantly different between groups, satisfaction was better (P <0.001) and mouth drier (P <0.001) in group O than in group M. Conclusion: These results give good arguments for an improvement in gas exchange and better tolerance of high-flow nasal oxygen (Optiflow™) versus classical high-flow oxygen face mask in postoperative cardiac patients. These results must be confirmed by a randomised study with a larger population. [Copyright &y& Elsevier]

Abstract: We report a case of Lemierre''s syndrome complicated with pulmonary septic abscesses, leading to necrotizing pneumonia. In spite of administration of appropriate antibiotics and a protective ventilation strategy, the patient had several bilateral pneumothoraces. In this setting, the mechanical ventilation was unsuccessful leading to two hypoxia-related cardiac arrests. An extracorporeal CO2 removal was then carried out for 34-days duration. The patient was weaned from mechanical ventilation on day 68. He was then transferred to the chest surgery unit on day 83. [Copyright &y& Elsevier]

Abstract: Objectives: To assess the prognosis of newborn infants with refractory hypoxemia who required extracorporeal membrane oxygenation (ECMO). Methods: Eighty-nine newborn infants treated by ECMO during more than 24 hours over a 8-year period (1996–2003) were included in this observational cohort study with a 9-month and 24-month evaluation. Results: Respiratory failure mainly resulted from meconium aspiration syndrome (MAS, 43%), congenital diaphragmatic hernia (CDH, 15%) and sepsis (15%). Overall survival at hospital discharge was 67%. Infants with MAS had the best survival rate (82%) and those with CDH had the worst (46%). Of the remaining 60 survivors, 53% remained oxygen dependent at 28 days and 33% at 45 days. At the age of 2 years, only 1 infant remained oxygen dependent (but did not required oxygen at 3 years) and only 3 infants had significant neurodevelopmental problems. CDH group was associated with a prolonged duration in supplementary oxygen (P <0.001) and a prolonged duration for tube feeding (P =0.01) as compared with other diagnoses. Regarding neurologic outcome, CDH infants had the poorer neurological acquisition rate at 9 months but a very good evolution by the time of the 24-month evaluation. Conclusions: Morbidity in ECMO survivors is low considering the severity of illness in the newborn period, mainly related to pulmonary and feeding dysfunctions during the first months, in particular for the CDH group. Outcome at the age of 2 years of CDH infants is most often favourable regarding growth and neurodevelopmental evolution. [Copyright &y& Elsevier]

Résumé: Les traumatismes crâniens graves sont particulièrement sensibles à l’hypoxémie. Les moyens de recouvrir une oxygénation adéquate chez les patients associant des lésions crâne-poumon sont peu décrits. Nous rapportons le cas d’un recours à l’ECMO chez une jeune patiente neurolésée, en hypoxémie réfractaire dans les suites d’un polytraumatisme. [ABSTRACT FROM AUTHOR]

Abstract: Respiratory support using extra corporeal membrane oxygenation (ECMO) is rarely used in the setting of adult lung surgery, with the exception of lung transplantation. We report the case of a patient with pulmonary aspergilloma, for whom selective bronchial intubation was required to facilitate surgery. Intolerance to unilateral ventilation was anticipated due to poor underlying lung function. Intra-operatively, an attempt to lung exclusion was responsible for severe hypoxemia. The use of veno-venous ECMO allowed to improve oxygenation and lung resection was carried out successfully at the expense of major intra-operative bleeding. [Copyright &y& Elsevier]