case report - Nederlandse Vereniging voor Anesthesiologie
case report - Nederlandse Vereniging voor Anesthesiologie
case report - Nederlandse Vereniging voor Anesthesiologie
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maart '10 nederlands tijdschrift <strong>voor</strong> anesthesiologie 29<br />
|<br />
<strong>case</strong> <strong>report</strong><br />
1 Intensive Care, Universitair Medisch<br />
Centrum Utrecht.<br />
contactinformatie<br />
Novalung en<br />
A. Kulk<br />
Joost van Geelstraat 35<br />
3021 VK Rotterdam<br />
Email annemiekekulk@hotmail.com<br />
non-invasieve<br />
beademing als bridge<br />
to transplant<br />
A. Kulk, Drs. 1<br />
R. Braams, Dr. 1<br />
abstract Introduction Pre-transplant mechanical ventilation in lung transplant<br />
(LTx) patients is associated with increased morbidity and mortality after<br />
LTx and therefore considered a (relative) contraindication for LTx. Unfortunately<br />
due to organ shortage an increasing number of patients in the Euro<br />
Transplant region require mechanical ventilation before high-urgency LTx. We<br />
describe the combined use of the Novalung interventional lung assist (iLA) device<br />
and non-invasive ventilation (NIV) in a patient waiting for a high-urgency<br />
LTx. Methods A Novalung (iLA) device was implanted in a hemodynamically stable<br />
26 year old male diagnosed with non-specific interstitial pneumonitis, because<br />
of increasing hypercapnia despite NIV. Results After admission to the ICU<br />
the patient was started on NIV because of an increasing respiratory acidosis due<br />
to hypercapnia (pCO2 82 mmHg/ 10,9 kPa on admission to the ICU). On day 4<br />
despite NIV the pCO2 had increased to 112 mm Hg/ 14,9 kPa while oxygenation<br />
remained relatively unaffected. In an effort to prevent invasive mechanical ventilation<br />
an iLA device was implanted and intravenous heparin was started. With<br />
the combination of NIV and iLA pCO2 decreased to 62 mmHg/ 8,2 kPa on day<br />
5 post-implant and remained at this level until day 7 when a successful LTx was<br />
performed. The iLA was tolerated well by the (awake) patient and no bleeding<br />
complications occurred. Conclusion In selected patients waiting for a LTx,<br />
the combination of NIV and Novalung iLA can prevent pre-transplant invasive<br />
mechanical ventilation thereby offering a bridge to transplant.<br />
Keywords: Bridge to transplant, Lung transplant, Mechanical ventilation, Novalung iLA device.
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