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Inhaled Epoprostenol to Facilitate Safe Transport in Legionnaires’ Disease

Published online by Cambridge University Press:  09 January 2020

Corrine Foster ,
Michael A. Frakes ,
Erica Puopolo ,
Francis McNulty ,
Mark S. Saia ,
Mike Hourihan ,
Margaret Flynn  and
Susan R. Wilcox [Opens in a new window]
Corrine Foster
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA
Michael A. Frakes
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA
Erica Puopolo
Affiliation:
North Shore Medical Center, Boston, MassachusettsUSA
Francis McNulty
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA
Mark S. Saia
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA
Mike Hourihan
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA
Margaret Flynn
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA
Susan R. Wilcox
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA Massachusetts General Hospital, Boston, MassachusettsUSA
Corresponding
E-mail address:
Swilcox1@partners.org
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Abstract

Hypoxemic patients often desaturate further with movement and transport. While inhaled epoprostenol does not improve mortality, improving oxygenation allows for transport of severely hypoxemic patients to tertiary care centers with a related improvement in mortality rates. Extracorporeal membrane oxygenation (ECMO) use is increasing in frequency for patients with refractory hypoxemia, and with increasing regionalization of care, safe transport of hypoxemic patients only becomes more important. In this series, four cases are presented of young patients with severe hypoxemic respiratory failure from Legionnaires’ disease transported on inhaled epoprostenol to ECMO centers for consideration of cannulation. With continued climate changes, Legionella and other pathogens are likely to be a continued threat. As such, optimizing oxygenation to allow for transport should continue to be a priority for critical care transport (CCT) services.

Keywords

acute respiratory distress syndrome hypoxemia inhaled epoprostenol Legionnaires’ disease Legionella acute respiratory distress syndrome body mass index critical care transport extracorporeal membrane oxygenation emergency department fraction of inspired oxygen intensive care unit inhaled nitric oxide intravenous neuromuscular blockade partial pressure of oxygen positive end expiratory pressure peak inspiratory pressure oxygen saturation
Type
Case Report
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 1 , February 2020 , pp. 109 - 114
Copyright
© World Association for Disaster and Emergency Medicine 2020

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