Cai ZY, Xu BP, Zhang WH, Peng HW, Xu Q, Yu HB, Chu QG, Zhou SS. Acute respiratory distress syndrome following multiple wasp stings treated with extracorporeal membrane oxygenation: A case report. World J Clin Cases 2022; 10(30): 11122-11127 [PMID: 36338203 DOI: 10.12998/wjcc.v10.i30.11122]
Corresponding Author of This Article
Bao-Ping Xu, MD, Chief Doctor, Department of Critical Care Medicine, Traditional Chinese Hospital of Lu'an Affiliated to Anhui University of Traditional Chinese Medicine, No. 76 Renmin Road, Lu'an 237000, Anhui Province, China. xu131406@qq.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Zheng-Yin Cai, Bao-Ping Xu, Wei-Hao Zhang, Huai-Wen Peng, Qing Xu, Huai-Bin Yu, Department of Critical Care Medicine, Traditional Chinese Hospital of Lu'an Affiliated to Anhui University of Traditional Chinese Medicine, Lu'an 237000, Anhui Province, China
Quan-Gen Chu, Department of Chinese Medicine, Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
Shu-Sheng Zhou, Department of Intensive Care Unit, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, Anhui Province, China
Author contributions: Cai ZY and Xu BP conceived and designed the study; Peng HW and Yu HB provided administrative support; Xu Q and Zhou SS provided the study materials or patient care/data; Zhang WH and Chu QG collected the data; Xu BP conducted the data analyses and interpretation; all authors contributed to the manuscript writing and gave final approval of the manuscript.
Informed consent statement: Informed and written consent was obtained from the patient to use his clinical information and data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bao-Ping Xu, MD, Chief Doctor, Department of Critical Care Medicine, Traditional Chinese Hospital of Lu'an Affiliated to Anhui University of Traditional Chinese Medicine, No. 76 Renmin Road, Lu'an 237000, Anhui Province, China. xu131406@qq.com
Received: June 9, 2022 Peer-review started: June 9, 2022 First decision: June 27, 2022 Revised: July 7, 2022 Accepted: September 16, 2022 Article in press: September 16, 2022 Published online: October 26, 2022
Abstract
BACKGROUND
It is necessary for clinicians to be aware of a rare but possible acute respiratory distress syndrome (ARDS) complication caused by multiple wasp stings. Severe ARDS has a high mortality rate but no specific pharmacotherapies have been identified to date. This case study presents the first case of severe ARDS caused by multiple wasp stings, treated successfully with extracorporeal membrane oxygenation (ECMO). It also emphasizes the effectiveness of early ECMO treatment for severe ARDS with persistent hypoxemia.
CASE SUMMARY
A 24-year-old woman was admitted to the emergency department after being stung by more than 10 wasps within a 30-min period, with clinical symptoms of multiple rashes, dizziness, chest tightness, nausea, and vomiting. On the 2nd day of admission, the patient developed progressive dyspnea. The patient was diagnosed with ARDS based on clinical manifestations and lung computed tomography (CT) scan. Because of the progressive dyspnea, the intensive care unit physician performed endotracheal intubation and continued to provide ventilator support, but the patient’s respiratory distress worsened, as indicated by the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen. Veno-venous ECMO was initiated for 6 d. On day 7 of admission, ECMO was stopped. On the 11th day of admission, CT scan of the lungs revealed significant reduction of ground-glass opacities and consolidations. After about 2 wk, the patient recovered completely from ARDS and was discharged to home. At the 2-mo follow-up, the patient was in good health with no recurrence of dyspnea nor chest tightness.
CONCLUSION
ARDS complication caused by multiple wasp stings may be fatal when mechanical ventilation becomes dangerous due to persistent hypoxemia and despite optimization of ARDS management. We propose that the early implementation of ECMO is a relatively effective treatment, although the evidence is relatively limited.
Core Tip: It is necessary for clinicians to be aware of a rare but possible acute respiratory distress syndrome (ARDS) complication caused by multiple wasp stings. To date, there is no evidence of the extracorporeal membrane oxygenation (ECMO) treatment for ARDS or respiratory failure caused by wasp stings. For the first time, we report a case of severe ARDS caused by multiple wasp stings, successfully treated with ECMO.
