Article: Management of two circulations in a COVID-19 patient with secondary superinfection

Authors: Rachael Stadlen, Arun K Singhal, Robert M Reed, Jeffrey D Hasday, Melissa L Bates, Gregory A Schmidt, Michael Eberlein

Journal: Physiol Rep. 2023 Feb;11(4):e15602

Abstract:
Optimal oxygenation in the intensive care unit requires adequate pulmonary gas exchange, oxygen-carrying capacity in the form of hemoglobin, sufficient delivery of oxygenated hemoglobin to the tissue, and an appropriate tissue oxygen demand. In this Case Study in Physiology, we describe a patient with COVID-19 whose pulmonary gas exchange and oxygen delivery were severely compromised by COVID-19 pneumonia requiring extracorporeal membrane oxygenation (ECMO) support. His clinical course was complicated by a secondary superinfection with staphylococcus aureus and sepsis. This case study is provided with two goals in mind (1) We outline how basic physiology was used to address life-threatening consequences of a novel infection-COVID-19. (2) We describe a strategy of whole-body cooling to lower the cardiac output and oxygen consumption, use of the shunt equation to optimize flow to the ECMO circuit, and transfusion to improve oxygen-carrying capacity when ECMO alone failed to provide sufficient oxygenation.

Link to journal online:
https://physoc.onlinelibrary.wiley.com/doi/10.14814/phy2.15602