Sistemik Lupus Eritematozus Hastasında Akut Respiratuar Distres Sendromu Tedavisinin Ekstrakorporeal Membran Oksijenasyonu ve Pulse Steroid ile Yönetimi
Özet
Sistemik lupus eritematozus (SLE) ve hipertansiyon (HT) tanısı ile takipli elli dört yaşında bayan hasta solunum sıkıntısı, ateş ve öksürük şikayeti ile müracaat etti. Yapılan fizik muayene ve tetkikler sonrası pnömoni tanısı ile servise yatırıldı. Medikal tedavisinin otuzaltıncı saatinde genel durumunda bozulma ve hipoksemi nedeniyle Anesteziyolojı ve Reanimasyon yoğun bakım ünitesine (ARYBÜ) devir alındı. Yoğun bakıma gelişinin altıncı saatinde hemodinamisinin ani bozulması ve hipoksemisinin kritik seviyeye ulaşması nedeni ile acil olarak entübe edildi. Solunum desteğine rağmen hastada klinik düzelme olmadı. Akut lupus pnömonitis ve akut respiratuar distress sendromu(ARDS) ön tanıları düşünülerek entübasyon sonrası otuzuncu dakikada venovenöz ekstrakorporeal membran oksijenasyonu (VV-ECMO) uygulandı. ARDS tedavisi için pulse metilprednizolon tedaviye eklendi ve dozu beş günde bir azaltıldı. ARDS kliniğinin toparlanması sonrası ECMO yedi günde sonlandırıldı. Onbirinci günde ekstübe edilen hasta servisdeki rehabilitasyon sürecinin ardından taburcu edildi. Mortalitesi yüksek olan akut lupus pnömotise bağlı ARDS kliniği VV-ECMO ve pulse steroid ile başarılı şekilde tedavi edildi.
A fifty-four-year-old female patient, who was followed up with the diagnosis of systemic lupus erythematosus (SLE) and hypertension (HT), applied with complaints of respiratory distress, fever and cough. After physical examination and tests, she was admitted to the ward with the diagnosis of pneumonia. At the thirty-sixth hour of her medical treatment, she was transferred to the Anesthesiology and Reanimation Intensive Care Unit (ARICU) due to deterioration in her general condition and hypoxemia. At the sixth hour of her arrival in the intensive care unit, she was urgently intubated due to sudden deterioration in her hemodynamics and reaching a critical level of hypoxemia. Despite respiratory support, the patient did not improve clinically. Considering the preliminary diagnoses of acute lupus pneumonitis and acute respiratory distress syndrome (ARDS), venovenous extracorporeal membrane oxygenation (VV-ECMO) was applied at the thirty-minute after intubation. Pulse methylprednisolone was added to the treatment for ARDS and the dose was reduced every five days. After the ARDS clinical recovery, ECMO was terminated in seven days. The patient was extubated on the eleventh day and discharged after the rehabilitation process in the ward. ARDS clinical due to acute lupus pneumonia with high mortality was successfully treated with VV-ECMO and pulse steroid.
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