title: [Successful Extracorporeal Membrane Oxygenation for a Patient with Nearly Fatal Hypoxemia Induced by Transfusion-related Acute Lung Injury].
abstract: Transfusion-related acute lung injury (TRALI) is known to be the leading cause of transfusion-related mortality. A nearly fatal case of postoperative TRALI, successfully managed with extracorporeal membrane oxygenation (ECMO), is reported. The patient was a 70-year-old woman for whom laparoscopic nephrectomy was planned. She received several units of packed red blood cells and fresh-frozen plasma (FFP) intraoperatively due to massive bleeding. At the end of the operation, her PaO2/FIO2 ratio was 504, and she was extubated. Shortly after extubation, she developed severe hypoxemia. A chest X-ray showed bilateral infiltrates without cardiac enlargement. After entering the ICU, her respiratory condition deteriorated rapidly despite treatment with noninvasive positive pressure ventilation followed by re-intubation 8 hours after the operation. Even with very high positive pressure ventilation above 35 mmHg, her oxygenation decreased to PaO2 39.9 mmHg (FIO2 1.0). As a lifesaving measure, venovenous ECMO was started 15 hours after the operation. The pulmonary infiltration improved significantly over the next 5 days. Anti-HLA antibodies were detected in the FFP donor serum, that was transfused at the time of extubation. Now that TRALI is thought to be reversible, ECMO might be useful for even what was previously fatal hypoxemia.
authors.forename: Ayako
authors.initials: A
authors.lastname: Honda
authors.forename: Masato
authors.initials: M
authors.lastname: Morita
authors.forename: Akiko
authors.initials: A
authors.lastname: Taniguchi
authors.forename: Akihiko
authors.initials: A
authors.lastname: Tabuchi
authors.forename: Sadahiro
authors.initials: S
authors.lastname: Kubo
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology*; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D010949:Plasma; D017713:Platelet Transfusion; D011175:Positive-Pressure Respiration; D013902:Radiography, Thoracic; D012121:Respiration, Artificial; D065227:Transfusion Reaction