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          The flagship journal of the Society for Endocrinology. Learn more

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      Acute respiratory distress syndrome in a case of diabetic ketoacidosis requiring ECMO support

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          Abstract

          Summary

          Acute respiratory distress syndrome (ARDS) is a rare but life-threatening complication of diabetic ketoacidosis (DKA). We present the case of a young female, with no previous diagnosis of diabetes, presenting in DKA complicated by ARDS requiring extra corporeal membrane oxygenation (ECMO) ventilator support. This case report highlights the importance of early recognition of respiratory complications of severe DKA and their appropriate management.

          Learning points

          • ARDS is a very rare but life-threatening complication in DKA.

          • The incidence of ARDS remains unknown but less frequent than cerebral oedema in DKA.

          • The mechanism of ARDS in DKA has multifactorial aetiology, including genetic predisposition.

          • Early recognition and consideration of rare pulmonary complication of DKA can increase survival rate and provide very satisfactory outcomes.

          • DKA patients who present with refractory ARDS can be successfully rescued by ECMO support.

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          Most cited references20

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          Acute respiratory distress syndrome: the Berlin Definition.

          V Ranieri, Gordon D Rubenfeld, B Taylor Thompson … (2012)
          The acute respiratory distress syndrome (ARDS) was defined in 1994 by the American-European Consensus Conference (AECC); since then, issues regarding the reliability and validity of this definition have emerged. Using a consensus process, a panel of experts convened in 2011 (an initiative of the European Society of Intensive Care Medicine endorsed by the American Thoracic Society and the Society of Critical Care Medicine) developed the Berlin Definition, focusing on feasibility, reliability, validity, and objective evaluation of its performance. A draft definition proposed 3 mutually exclusive categories of ARDS based on degree of hypoxemia: mild (200 mm Hg < PaO2/FIO2 ≤ 300 mm Hg), moderate (100 mm Hg < PaO2/FIO2 ≤ 200 mm Hg), and severe (PaO2/FIO2 ≤ 100 mm Hg) and 4 ancillary variables for severe ARDS: radiographic severity, respiratory system compliance (≤40 mL/cm H2O), positive end-expiratory pressure (≥10 cm H2O), and corrected expired volume per minute (≥10 L/min). The draft Berlin Definition was empirically evaluated using patient-level meta-analysis of 4188 patients with ARDS from 4 multicenter clinical data sets and 269 patients with ARDS from 3 single-center data sets containing physiologic information. The 4 ancillary variables did not contribute to the predictive validity of severe ARDS for mortality and were removed from the definition. Using the Berlin Definition, stages of mild, moderate, and severe ARDS were associated with increased mortality (27%; 95% CI, 24%-30%; 32%; 95% CI, 29%-34%; and 45%; 95% CI, 42%-48%, respectively; P < .001) and increased median duration of mechanical ventilation in survivors (5 days; interquartile [IQR], 2-11; 7 days; IQR, 4-14; and 9 days; IQR, 5-17, respectively; P < .001). Compared with the AECC definition, the final Berlin Definition had better predictive validity for mortality, with an area under the receiver operating curve of 0.577 (95% CI, 0.561-0.593) vs 0.536 (95% CI, 0.520-0.553; P < .001). This updated and revised Berlin Definition for ARDS addresses a number of the limitations of the AECC definition. The approach of combining consensus discussions with empirical evaluation may serve as a model to create more accurate, evidence-based, critical illness syndrome definitions and to better inform clinical care, research, and health services planning.
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            Acute Respiratory Distress Syndrome

            Jeffrey M Drazen, B Taylor Thompson, Rachel C. Chambers … (2017)
            Article 0 comments Cited 622 times – based on 0 reviews     Review now
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              The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology

              Jonathan Millar, Jonathon P Fanning, Charles Mcdonald … (2016)
              Extracorporeal membrane oxygenation (ECMO) is a technology capable of providing short-term mechanical support to the heart, lungs or both. Over the last decade, the number of centres offering ECMO has grown rapidly. At the same time, the indications for its use have also been broadened. In part, this trend has been supported by advances in circuit design and in cannulation techniques. Despite the widespread adoption of extracorporeal life support techniques, the use of ECMO remains associated with significant morbidity and mortality. A complication witnessed during ECMO is the inflammatory response to extracorporeal circulation. This reaction shares similarities with the systemic inflammatory response syndrome (SIRS) and has been well-documented in relation to cardiopulmonary bypass. The exposure of a patient’s blood to the non-endothelialised surface of the ECMO circuit results in the widespread activation of the innate immune system; if unchecked this may result in inflammation and organ injury. Here, we review the pathophysiology of the inflammatory response to ECMO, highlighting the complex interactions between arms of the innate immune response, the endothelium and coagulation. An understanding of the processes involved may guide the design of therapies and strategies aimed at ameliorating inflammation during ECMO. Likewise, an appreciation of the potentially deleterious inflammatory effects of ECMO may assist those weighing the risks and benefits of therapy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Endocrinol Diabetes Metab Case Rep
                Journal ID (iso-abbrev): Endocrinol Diabetes Metab Case Rep
                Journal ID (hwp): EDM
                Title: Endocrinology, Diabetes & Metabolism Case Reports
                Publisher: Bioscientifica Ltd (Bristol )
                ISSN (Electronic): 2052-0573
                Publication date (Electronic): 15 June 2021
                Publication date Collection: 2021
                Volume: 2021
                Electronic Location Identifier: 20-0192
                Affiliations
                [1 ]Department of Endocrinology and Diabetes , Beaumont Hospital, Dublin, Ireland
                [2 ]School of Medicine , Royal College of Surgeons in Ireland, Dublin, Ireland
                Author notes
                Correspondence should be addressed to M Darrat; Email: miladmustafa7@ 123456yahoo.com
                Article
                Publisher ID: EDM200192
                DOI: 10.1530/EDM-20-0192
                PMC ID: 8284957
                PubMed ID: 34236038
                SO-VID: 18d299f1-ded3-4205-b544-88d70a86df2a
                Copyright © © The authors
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License..

                History
                Date received : 12 May 2021
                Date accepted : 15 June 2021
                Categories
                Subject: Adult
                Subject: Female
                Subject: White
                Subject: Ireland
                Subject: Pancreas
                Subject: Diabetes
                Subject: Unique/Unexpected Symptoms or Presentations of a Disease
                Subject: Unique/Unexpected Symptoms or Presentations of a Disease

                Keywords: adult,female,white,ireland,pancreas,diabetes,unique/unexpected symptoms or presentations of a disease,july,2021
                Data availability:
                Keywords: adult, female, white, ireland, pancreas, diabetes, unique/unexpected symptoms or presentations of a disease, july, 2021

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