High frequency oscillatory ventilation in leptospirosis pulmonary hemorrhage syndrome: A case series study
Mohd Mat Nor, Azrina Md Ralib, Noor Airini Ibrahim, Mohd Rasydan Abdul-Ghani
Acute respiratory distress syndrome, high frequency oscillatory ventilation, hypoxemia, leptospirosis, pulmonary hemorrhage
Citation Information :
Mat Nor M, Md Ralib A, Ibrahim NA, Abdul-Ghani MR. High frequency oscillatory ventilation in leptospirosis pulmonary hemorrhage syndrome: A case series study. Indian J Crit Care Med 2016; 20 (6):342-348.
Hypoxemia in severe leptospirosis-associated pulmonary hemorrhage syndrome (LPHS) is a challenging clinical scenario not usually responsive to maximal support on mechanical ventilation. We described the efficacy and safety of high frequency oscillatory ventilation (HFOV) as rescue therapy in acute respiratory failure secondary to LPHS. This is a retrospective case study of five patients with diagnosis of severe LPHS, who were admitted to Intensive Care Unit from October 2014 to January 2015. They developed refractory hypoxemia on conventional mechanical ventilation and rescue therapy was indicated. All patients responded rapidly by showing improvements in oxygen index and PaO2/FiO2ratio within first 72 h of therapy. Despite severity of illness evidenced by high Simplified Acute Physiological II and Sequential Organ Failure Assessment scores, all patients were discharged from hospital alive. In view of the rapid onset and extent of hemorrhage which may culminate quickly into asphyxiation and death, HFOV may indeed be lifesaving in severe LPHS.
Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, et al. Global morbidity and mortality of leptospirosis: A systematic review. PLoS Negl Trop Dis 2015;9:e0003898.
Segura ER, Ganoza CA, Campos K, Ricaldi JN, Torres S, Silva H, et al. Clinical spectrum of pulmonary involvement in leptospirosis in a region of endemicity, with quantification of leptospiral burden. Clin Infect Dis 2005;40:343-51.
Yersin C, Bovet P, Mérien F, Clément J, Laille M, Van Ranst M, et al. Pulmonary haemorrhage as a predominant cause of death in leptospirosis in Seychelles. Trans R Soc Trop Med Hyg 2000;94:71-6.
Ministry of Health Malaysia. Guidelines for the diagnosis, management, prevention and control of leptospirosis in Malaysia. 2011. p. 41.
Dolhnikoff M, Mauad T, Bethlem EP, Carvalho CR. Pathology and pathophysiology of pulmonary manifestations in leptospirosis. Braz J Infect Dis 2007;11:142-8.
Croda J, Neto AN, Brasil RA, Pagliari C, Nicodemo AC, Duarte MI. Leptospirosis pulmonary haemorrhage syndrome is associated with linear deposition of immunoglobulin and complement on the alveolar surface. Clin Microbiol Infect 2010;16:593-9.
De Brito T, Aiello VD, da Silva LF, Gonçalves da Silva AM, Ferreira da Silva WL, Castelli JB, et al. Human hemorrhagic pulmonary leptospirosis: Pathological findings and pathophysiological correlations. PLoS One 2013;8:e71743.
Kumar S. Indian guidelines for the diagnosis and management of human leptospirosis. Mortality 2012;5:23-9.
Vieira SR, Brauner JS. Leptospirosis as a cause of acute respiratory failure: Clinical features and outcome in 35 critical care patients. Braz J Infect Dis 2002;6:135-9.
Fessler HE, Derdak S, Ferguson ND, Hager DN, Kacmarek RM, Thompson BT, et al. Aprotocol for high-frequency oscillatory ventilation in adults: Results from a roundtable discussion. Crit Care Med 2007;35:1649-54.
Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med 2015;372:747-55.
Assimakopoulos SF, Fligou F, Marangos M, Zotou A, Psilopanagioti A, Filos KS. Anicteric leptospirosis-associated severe pulmonary hemorrhagic syndrome: A case series study. Am J Med Sci 2012;344:326-9.
Shenoy VV, Nagar VS, Chowdhury AA, Bhalgat PS, Juvale NI. Pulmonary leptospirosis: An excellent response to bolus methylprednisolone. Postgrad Med J 2006;82:602-6.
Trivedi SV, Vasava AH, Bhatia LC, Patel TC, Patel NK, Patel NT. Plasma exchange with immunosuppression in pulmonary alveolar haemorrhage due to leptospirosis. Indian J Med Res 2010;131:429-33.
Arokianathan D, Trower K, Pooboni S, Sosnowski A, Moss P, Thaker H. Leptospirosis: A case report of a patient with pulmonary haemorrhage successfully managed with extra corporeal membrane oxygenation. J Infect 2005;50:158-62.
Hodgson C, Carteaux G, Tuxen DV, Davies AR, Pellegrino V, Capellier G, et al. Hypoxaemic rescue therapies in acute respiratory distress syndrome: Why, when, what and which one? Injury 2013;44:1700-9.
Ferguson ND, Cook DJ, Guyatt GH, Mehta S, Hand L, Austin P, et al. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med 2013;368:795-805.
Young D, Lamb SE, Shah S, MacKenzie I, Tunnicliffe W, Lall R, et al. High-frequency oscillation for acute respiratory distress syndrome. N Engl J Med 2013;368:806-13.
Duval EL, Markhorst DG, Ramet J, van Vught AJ. High-frequency oscillatory ventilation in severe lung haemorrhage: A case study of three centres. Respir Med CME 2009;2:92-8.