Bleomycin-induced lung injury treated with venovenous extracorporeal membrane oxygenation (ECMO) and ultra-protective ventilator settings.
Mazen Faris OdishWilliam Cameron McGuirePatricia ThistlethwaiteLaura E Crotty AlexanderPublished in: BMJ case reports (2020)
Bleomycin treats malignancies, such as germ cell tumours and Hodgkin lymphoma. While efficacious, it can cause severe drug-induced lung injury. We present a 42-year-old patient with stage IIB seminoma treated with radical orchiectomy followed by adjuvant chemotherapy with bleomycin, etoposide and cisplatin. His postbleomycin course was complicated by the rapid onset of hypoxic respiratory failure, progressing to acute respiratory distress syndrome and requiring venovenous extracorporeal membrane oxygenation (VV-ECMO) support. Although the patient was treated with high dose systemic steroids and ultra-protective ventilator strategies to minimise ventilator-induced lung injury while on VV-ECMO, his lung injury failed to improve. Care was withdrawn 29 days later. Lung autopsy revealed diffuse organising pneumonia. We found six case reports (including this one) of bleomycin-induced lung injury requiring VV-ECMO with a cumulative survival of 33% (2/6). While VV-ECMO may be used to bridge patients to recovery or lung transplant, the mortality is high.
Keyphrases
- extracorporeal membrane oxygenation
- acute respiratory distress syndrome
- respiratory failure
- drug induced
- liver injury
- mechanical ventilation
- pulmonary fibrosis
- hodgkin lymphoma
- high glucose
- high dose
- newly diagnosed
- case report
- germ cell
- diabetic rats
- healthcare
- end stage renal disease
- high resolution
- chronic kidney disease
- low dose
- risk factors
- prognostic factors
- palliative care
- intensive care unit
- cardiovascular events
- ejection fraction
- single cell
- coronary artery disease
- cardiovascular disease
- quality improvement
- adverse drug
- endothelial cells