Management of two circulations in a COVID-19 patient with secondary superinfection.
Rachael StadlenArun K SinghalRobert M ReedJeffrey D HasdayMelissa L BatesGregory A SchmidtMichael EberleinPublished in: Physiological reports (2023)
Optimal oxygenation in the intensive care unit requires adequate pulmonary gas exchange, oxygen-carrying capacity in the form of hemoglobin, sufficient delivery of oxygenated hemoglobin to the tissue, and an appropriate tissue oxygen demand. In this Case Study in Physiology, we describe a patient with COVID-19 whose pulmonary gas exchange and oxygen delivery were severely compromised by COVID-19 pneumonia requiring extracorporeal membrane oxygenation (ECMO) support. His clinical course was complicated by a secondary superinfection with staphylococcus aureus and sepsis. This case study is provided with two goals in mind (1) We outline how basic physiology was used to address life-threatening consequences of a novel infection-COVID-19. (2) We describe a strategy of whole-body cooling to lower the cardiac output and oxygen consumption, use of the shunt equation to optimize flow to the ECMO circuit, and transfusion to improve oxygen-carrying capacity when ECMO alone failed to provide sufficient oxygenation.
Keyphrases
- extracorporeal membrane oxygenation
- coronavirus disease
- acute respiratory distress syndrome
- sars cov
- respiratory failure
- staphylococcus aureus
- case report
- mechanical ventilation
- respiratory syndrome coronavirus
- intensive care unit
- public health
- heart failure
- pulmonary artery
- septic shock
- atrial fibrillation
- carbon dioxide
- coronary artery
- ionic liquid