Management of two circulations in a COVID‐19 patient with secondary superinfection

Rachael Stadlen; Arun K. Singhal; Robert M. Reed; Jeffrey D. Hasday; Melissa L. Bates; Gregory A. Schmidt; Michael Eberlein

doi:10.14814/phy2.15602

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Management of two circulations in a COVID‐19 patient with secondary superinfection

Journal article

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Peer reviewed

Management of two circulations in a COVID‐19 patient with secondary superinfection

Rachael Stadlen, Arun K. Singhal, Robert M. Reed, Jeffrey D. Hasday, Melissa L. Bates, Gregory A. Schmidt and Michael Eberlein

Physiological reports, Vol.11(4), e15602

02/17/2023

DOI: 10.14814/phy2.15602

PMCID: PMC9937791

PMID: 36802120

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Abstract

Optimal oxygenation in the intensive care unit requires adequate pulmonary gas exchange, oxygen‐carrying capacity in the form of hemoglobin, sufficient delivery of oxygenated hemoglobin to the tissue, and an appropriate tissue oxygen demand. In this Case Study in Physiology, we describe a patient with COVID‐19 whose pulmonary gas exchange and oxygen delivery were severely compromised by COVID‐19 pneumonia requiring extracorporeal membrane oxygenation (ECMO) support. His clinical course was complicated by a secondary superinfection with staphylococcus aureus and sepsis. This case study is provided with two goals in mind (1) We outline how basic physiology was used to address life‐threatening consequences of a novel infection—COVID‐19. (2) We describe a strategy of whole‐body cooling to lower the cardiac output and oxygen consumption, use of the shunt equation to optimize flow to the ECMO circuit, and transfusion to improve oxygen‐carrying capacity when ECMO alone failed to provide sufficient oxygenation. COVID‐19 pneumonia can require extracorporeal membrane oxygenation (ECMO) support. The use of the shunt analogy and the shunt equation can be an important tool to analyze and optimize relative blood flow to the ECMO circuit and oxygenation. We describe a strategy of whole‐body cooling to lower the cardiac output and oxygen consumption in a COVID‐19 patient with critical hypoxia on VV‐ECMO.

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Case Report

Case Reports

cooling

COVID‐19

shunt equation

VV‐ECMO

Details

Title: Subtitle: Management of two circulations in a COVID‐19 patient with secondary superinfection
Creators: Rachael Stadlen - University of Iowa
Arun K. Singhal - University of Iowa
Robert M. Reed - University of Maryland, Baltimore
Jeffrey D. Hasday - University of Maryland, Baltimore
Melissa L. Bates - University of Iowa
Gregory A. Schmidt - University of Iowa
Michael Eberlein - University of Maryland, Baltimore
Resource Type: Journal article
Publication Details: Physiological reports, Vol.11(4), e15602
DOI: 10.14814/phy2.15602
PMID: 36802120
PMCID: PMC9937791
NLM abbreviation: Physiol Rep
eISSN: 2051-817X
Publisher: John Wiley and Sons Inc
Alternative title: Stadlen et al
Language: English
Date published: 02/17/2023
Academic Unit: Pulmonary, Critical Care, and Occupational Medicine; Stead Family Department of Pediatrics; Fraternal Order of Eagles Diabetes Research Center; Cardiothoracic Surgery; Health, Sport, and Human Physiology ; Internal Medicine
Record Identifier: 9984368061302771

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