Successful treatment of pulmonary injury due to nitrogen oxide exposure with extracorporeal membrane oxygenation: a report of two cases and literature review

Abstract

Background: Severe nitrogen oxide poisoning can lead to life-threatening pulmonary injury.

Methods: we report two cases of severe nitrogen-oxide-induced hypoxia treated with veno-venous extracorporeal membrane oxygenation (ECMO). After exposure, the conditions of both patients continued to deteriorate despite maximal mechanical ventilation with a fraction of inspired oxygen of 100%; therefore, we started veno-venous ECMO. The times from presentation to the initiation of ECMO in the two patients were 1 and 2 days. The hypoxemia and respiratory failure improved quickly after ECMO support.

Results: The patients were discharged without complications. The durations of ECMO for the two patients were 5 and 6 days.

Conclusion: This report describes how early ECMO support was used to treat potentially fatal pulmonary injury after exposure to nitrogen oxide. The duration of the ECMO run is a critical determinant of patient survival.

Keywords:

• Extracorporeal membrane oxygenation
• nitrogen oxide
• poisoning
• treatment
• pulmonary injury

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This report was supported by Medical Health Science and Technology Project of Zhejiang Province Health Commission (2018KY379,2019KY381) and Zhejiang Province Public Welfare Technology Application Research Project (CN), China (2019 LGF19H010009).