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array:22 [ "pii" => "S0300289624002291" "issn" => "03002896" "doi" => "10.1016/j.arbres.2024.06.009" "estado" => "S300" "fechaPublicacion" => "2024-10-01" "aid" => "3604" "copyrightAnyo" => "2024" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2024;60:660-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0300289624002308" "issn" => "03002896" "doi" => "10.1016/j.arbres.2024.06.010" "estado" => "S300" "fechaPublicacion" => "2024-10-01" "aid" => "3605" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2024;60:662-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Letter</span>" "titulo" => "Right Adrenal Metastasis of Lung Cancer Diagnosed via Endoscopic Ultrasound (EUS-B) by a Pulmonologist" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "662" "paginaFinal" => "663" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1647 "Ancho" => 2467 "Tamanyo" => 397561 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Coronal PET scan: mediastinal mass, right (thick arrow) and left adrenal (thin arrow). (B) and (C) Right adrenal gland (thick arrow) in axial PET scan (B) and EUS-B (C). (D) and (E) Left adrenal gland (thin arrow) in axial PET scan (D) and EUS-B (E).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Cascón-Hernández, Javier López-García, Imane Saidi" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Juan" "apellidos" => "Cascón-Hernández" ] 1 => array:2 [ "nombre" => "Javier" "apellidos" => "López-García" ] 2 => array:2 [ "nombre" => "Imane" "apellidos" => "Saidi" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289624002308?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000010/v1_202410020659/S0300289624002308/v1_202410020659/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0300289624002175" "issn" => "03002896" "doi" => "10.1016/j.arbres.2024.05.035" "estado" => "S300" "fechaPublicacion" => "2024-10-01" "aid" => "3593" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2024;60:658-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Letter</span>" "titulo" => "Organizing Pneumonia Secondary to ASIA Syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "658" "paginaFinal" => "659" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 989 "Ancho" => 1501 "Tamanyo" => 193577 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Bilateral lung opacities in both bases are seen in this posteroanterior chest X-ray. (B) Coronal cut of a CT scan showing an infiltrate with air bronchogram suggesting pneumonia in the left lower lobe. (C) Axial cut of a CT scan showing new bilateral patchy consolidations, mainly subpleural, and partial resolution of the ones seen in the previous study. (D) Haematoxylin–eosin staining shows fragments of lung parenchyma with of alveolar septa by acute and chronic polymorphous inflammatory infiltrate, alveolar spaces partially lined by pneumocytes with reactive atypia, predominantly occupied by fibrin and some Masson bodies. (E) Rupture of the breast implant. (F) Resolution of the consolidations in subsequent studies.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro Piñero-Gutiérrez, Felipe Villar-Álvarez, Paula Asensio-Mathews, David González-Peinado" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "Piñero-Gutiérrez" ] 1 => array:2 [ "nombre" => "Felipe" "apellidos" => "Villar-Álvarez" ] 2 => array:2 [ "nombre" => "Paula" "apellidos" => "Asensio-Mathews" ] 3 => array:2 [ "nombre" => "David" "apellidos" => "González-Peinado" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289624002175?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000010/v1_202410020659/S0300289624002175/v1_202410020659/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Letter</span>" "titulo" => "Use of Extracorporeal Carbon Dioxide Removal Therapy in an Intermediate Respiratory Care Unit" "tieneTextoCompleto" => true "saludo" => "To the Director," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "660" "paginaFinal" => "661" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Esther Barbero, Antonio Gomis, David Pestaña" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Esther" "apellidos" => "Barbero" "email" => array:1 [ 0 => "estherbarbero@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Antonio" "apellidos" => "Gomis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "David" "apellidos" => "Pestaña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Intermediate Respiratory Care Unit, Respiratory Service, Ramón y Cajal University Hospital, IRYCIS, School of Medicina-Alcalá de Henares University, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Nephrolophy Service, Ramón y Cajal Hospital, Ramón y Cajal University Hospital, IRYCIS, School of Medicina-Alcalá de Henares University, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Anaesthesia and Resuscitation Service, Ramón y Cajal University Hospital, IRYCIS, School of Medicina-Alcalá de Henares University, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 649 "Ancho" => 900 "Tamanyo" => 88325 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT scan of the patient before admission.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Extracorporeal carbon dioxide removal (ECCO<span class="elsevierStyleInf">2</span>R) is an advanced form of life support that is mostly used in patients with acute respiratory distress syndrome (ARDS) and severe acute exacerbations of chronic obstructive pulmonary disease (COPD) or asthma.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> For the former, ECCO<span class="elsevierStyleInf">2</span>R therapy allows ultra-protective lung ventilation and reduces ventilator-induced lung injury. For the latter, ECCO<span class="elsevierStyleInf">2</span>R therapy may be applied to prevent intubation in patients at risk of non-invasive ventilation (NIV) failure.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> Due to the need for venous cannulation and complexity of care, this technique is mainly used in Intensive Care Units (ICU).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> We present a case of successful treatment with a peristaltic pump ECCO<span class="elsevierStyleInf">2</span>R in an Intermediate Respiratory Care Unit (IRCU).</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 67-year-old male with a history of progressive pulmonary fibrosis after COVID-19 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), referred for evaluation for lung transplant at last pneumology follow-up, was admitted to the hospital because of severe respiratory insufficiency. His medical record included chronic lymphocytic leukaemia (in remission), pulmonary embolism and atrial fibrillation on anticoagulation. He presented with a recent onset of dyspnoea, cough with purulent sputum, fever and increased oxygen requirement. Blood pressure was 122/65<span class="elsevierStyleHsp" style=""></span>mmHg, pulse 100<span class="elsevierStyleHsp" style=""></span>bpm, SaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span> 112, and a respiratory rate of 40<span class="elsevierStyleHsp" style=""></span>bpm with scattered bilateral crackles. Blood gases showed respiratory acidosis (pH 7.27, pCO<span class="elsevierStyleInf">2</span> 116<span class="elsevierStyleHsp" style=""></span>mmHg, pO<span class="elsevierStyleInf">2</span> 38<span class="elsevierStyleHsp" style=""></span>mmHg, HCO<span class="elsevierStyleInf">3</span> 53.3<span class="elsevierStyleHsp" style=""></span>mM/L). A chest X-ray revealed a known interstitial pulmonary infiltrate without significant changes compared to his previous one. Laboratory studies showed an increased C-reactive protein (136.0<span class="elsevierStyleHsp" style=""></span>mg/L), leukocytosis (14.70<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10^3/μl), and neutrophilia (10.90<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10^3/μl). Since the patient had a do-not-intubate order, he was admitted to the IRCU.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">NIV was started but, after 24<span class="elsevierStyleHsp" style=""></span>h, the condition of the patient did not improve. Faced with this situation of non-invasive measures failure in a patient pending evaluation for lung transplant with a potentially reversible acute worsening due to an infectious disease as the most likely cause, the patient was connected to an ECCO<span class="elsevierStyleInf">2</span>R device (Prismalung+, Baxter) and empirical antibiotic treatment was started. Blood flow was kept between 250 and 300<span class="elsevierStyleHsp" style=""></span>ml/min and gas flow (oxygen) at 6–8<span class="elsevierStyleHsp" style=""></span>L/min, which was well tolerated by the patient, being able to withdraw NIV and deescalate to high-flow and finally conventional nasal cannulas. At the beginning of treatment ABG showed pH 7.4, pCO<span class="elsevierStyleInf">2</span> 93<span class="elsevierStyleHsp" style=""></span>mmHg, pO<span class="elsevierStyleInf">2</span> 88<span class="elsevierStyleHsp" style=""></span>mmHg and HCO<span class="elsevierStyleInf">3</span> 57.6<span class="elsevierStyleHsp" style=""></span>mM/L (PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span> 110), with persisting tachypnea (40<span class="elsevierStyleHsp" style=""></span>bpm) and work of breathing. After 24<span class="elsevierStyleHsp" style=""></span>h, ABG improved to pH 7.43, pCO<span class="elsevierStyleInf">2</span> 60<span class="elsevierStyleHsp" style=""></span>mmHg, pO<span class="elsevierStyleInf">2</span> 54<span class="elsevierStyleHsp" style=""></span>mmHg, HCO<span class="elsevierStyleInf">3</span> 39.8<span class="elsevierStyleHsp" style=""></span>mmHg with respiratory rate around 20<span class="elsevierStyleHsp" style=""></span>bpm, PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span> 135 and no dyspnoea. As the patient's clinical condition improved following medical treatment, it was possible to withdraw ECCO<span class="elsevierStyleInf">2</span>R after 6 days and the patient was discharged home.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The use of ECCO<span class="elsevierStyleInf">2</span>R has been reported in the ICU setting. This case represents the potential use of ECCO<span class="elsevierStyleInf">2</span>R in an IRCU in reversible situations refractory to non-invasive measures. Further research is required to determine the best way to implement this therapy in IRCU, to maximize its benefits while minimizing any potential risks.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">Esther Barbero Ph.D. None.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Antonio Gomis M.D. Has received lectures honoraria from Baxter International Inc., Deerfield, Illinois.</p><p id="par0040" class="elsevierStylePara elsevierViewall">David Pestaña Ph.D. Has received honoraria from Baxter International Inc. Baxter International Inc., Deerfield, Illinois; and B. Braun Medical S.A.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Artificial intelligence involvement</span><p id="par0045" class="elsevierStylePara elsevierViewall">Help of any artificial intelligence software or tool has not been use for this publication.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Artificial intelligence involvement" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 649 "Ancho" => 900 "Tamanyo" => 88325 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT scan of the patient before admission.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal carbon dioxide removal (ECCO2R) in patients with acute respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Morelli" 1 => "L. Del Sorbo" 2 => "A. Pesenti" 3 => "V.M. Ranieri" 4 => "E. Fan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-016-4673-0" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2017" "volumen" => "43" "paginaInicial" => "519" "paginaFinal" => "530" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28132075" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal carbon dioxide removal in the treatment of status asthmaticus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.J. Bromberger" 1 => "C. Agerstrand" 2 => "D. Abrams" 3 => "A. Serra" 4 => "D. Apsel" 5 => "Y. 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Feasibility and safety of extracorporeal CO<span class="elsevierStyleInf">2</span> removal to enhance protective ventilation in acute respiratory distress syndrome: the SUPERNOVA study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Combes" 1 => "V. Fanelli" 2 => "T. Pham" 3 => "V.M. Ranieri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-019-05567-4" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2019" "volumen" => "45" "paginaInicial" => "592" "paginaFinal" => "600" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30790030" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of extracorporeal carbon dioxide removal to avoid intubation in patients failing non-invasive ventilation – a cost analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Braune" 1 => "H. Burchardi" 2 => "M. Engel" 3 => "A. Nierhaus" 4 => "H. Ebelt" 5 => "M. Metschke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12871-015-0139-0" "Revista" => array:5 [ "tituloSerie" => "BMC Anesthesiol" "fecha" => "2015" "volumen" => "15" "paginaInicial" => "160" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26537233" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000006000000010/v1_202410020659/S0300289624002291/v1_202410020659/en/main.assets" "Apartado" => array:4 [ "identificador" => "98299" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cllinical Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000006000000010/v1_202410020659/S0300289624002291/v1_202410020659/en/main.pdf?idApp=UINPBA00003Z&text.app=https://www.archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289624002291?idApp=UINPBA00003Z" ]
