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Bleomycin-induced lung injury treated with venovenous extracorporeal membrane oxygenation (ECMO) and ultra-protective ventilator settings
  1. Mazen Faris Odish1,
  2. William Cameron McGuire1,
  3. Patricia Thistlethwaite2 and
  4. Laura E Crotty Alexander1
  1. 1Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA
  2. 2Surgery, Division of Cardiovascular and Thoracic Surgery, University of California San Diego, La Jolla, California, USA
  1. Correspondence to Dr Mazen Faris Odish; modish{at}health.ucsd.edu

Abstract

Bleomycin treats malignancies, such as germ cell tumours and Hodgkin lymphoma. While efficacious, it can cause severe drug-induced lung injury. We present a 42-year-old patient with stage IIB seminoma treated with radical orchiectomy followed by adjuvant chemotherapy with bleomycin, etoposide and cisplatin. His postbleomycin course was complicated by the rapid onset of hypoxic respiratory failure, progressing to acute respiratory distress syndrome and requiring venovenous extracorporeal membrane oxygenation (VV-ECMO) support. Although the patient was treated with high dose systemic steroids and ultra-protective ventilator strategies to minimise ventilator-induced lung injury while on VV-ECMO, his lung injury failed to improve. Care was withdrawn 29 days later. Lung autopsy revealed diffuse organising pneumonia. We found six case reports (including this one) of bleomycin-induced lung injury requiring VV-ECMO with a cumulative survival of 33% (2/6). While VV-ECMO may be used to bridge patients to recovery or lung transplant, the mortality is high.

  • mechanical ventilation
  • intensive care
  • chemotherapy
  • drugs: respiratory system
  • cardiothoracic surgery

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Footnotes

  • Contributors All authors made individual contributions to the writing of this case report, and approved the final version submitted. MFO contributed to the abstract, summary, figures, background, case presentation and discussion. WCMG contributed to the abstract, case presentation, discussion and patient perspective. PT contributed to the case presentation and discussion. LCA contributed to the abstract, summary, background, case presentation and discussion.

  • Funding This study was funded by National Institute of General Medical Sciences.

  • Competing interests None declared.

  • Patient consent for publication Parents/Guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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