[Extracorporeal CO2removal as life support system for a severe organizing pneumonia].
BACKGROUND
Acute lung injuries are usually found in intensive care unit. The diffuse alveolar damage (DAD) is the associated histological pattern and the most severe end-stage of the disease. Organizing pneumonia (OP), for which corticosteroids are the reference therapy, can mimic DAD. While postponing the response to treatment, to limit mechanical ventilation side effects, extracorporeal membrane oxygene can be proposed. We present a case of a severe OP for which extracorporeal CO2removal (ECCO2R) is used as a bridge to recovery under corticosteroid therapy.


METHODS
In the context of a flu-like syndrome, the non-recovery of a lung impairment is reported to a severe OP. ECCO2R is applied when using an ultraprotective ventilation and while waiting for lung healing under corticosteroid. This strategy allowed successful recovery, early physical therapy and active mobilization.


CONCLUSIONS
This observation presents the diagnostic and therapeutic difficulties of the lung parenchymental disease in intensive care. OP must be recognized. ECCO2R can be used in severe OP as a bridge to recovery while waiting for the corticosteroid efficacy.
Service de réanimation polyvalente, centre hospitalier de Montélimar, quartier Beausseret, BP 249, 26200 Montélimar, France; Service de pneumologie, centre hospitalier de Montélimar, quartier Beausseret, BP 249, 26200 Montélimar, France. Electronic address: gilles.rival@yahoo.fr.
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Rival
Service de réanimation polyvalente, centre hospitalier de Montélimar, quartier Beausseret, BP 249, 26200 Montélimar, France.
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Millet
Service de réanimation médicale adulte, pôle urgences-SAMU-réanimation, centre hospitalier régional universitaire, 4, boulevard Fleming, 25000 Besançon, France.
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Capellier
D002245:Carbon Dioxide / Q000493:pharmacokinetics; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care / Q000379:methods*; D008875:Middle Aged; D011014:Pneumonia / Q000473:pathology / Q000628:therapy*; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy; D012720:Severity of Illness Index
D002245:Carbon Dioxide
ARDS; Crazy paving; ECCO(2)R; Novalung(®); Organizing pneumonia; Pneumonie organisée; SDRA