Toxic flu H1N1 hospitalizes nurse for months -54 days on ECMO

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Found at Philadelphia inquirer:

When flu is toxic: Nurse lands in hospital for three months

David Templeton, Pittsburgh Post-Gazette

Posted: Saturday, September 27, 2014, 2:25 AM

PITTSBURGH-It started with a simple cough.

She dismissed it as just another seasonal cold on Jan. 2.

Two days later she had a 104-degree temperature prompting her to go to the Allegheny General Hospital emergency room, where she was diagnosed with pneumonia, prescribed antibiotics and sent home.

What happened next was a full-blown life-and-death emergency that Terri Thieret, 48, an AGH nurse of 25 years, never could have imagined after she forgot to get a flu shot because of the rat race of daily life: When her condition deteriorated further, she was forced back to the hospital and placed in the intensive care unit.

And there she would remain for the next three months...

...Two months without any bodily movement had left her feeling paralyzed. She was unable to lift her hand or raise her legs. She couldn't hold a pen or a phone. The months in bed also left her with a pressure ulcer on her back 5 inches in diameter and 3 inches deep into the muscle. Early in April, she was transferred to the West Penn Acute Rehab Unit and was released at the end of April, finally returning home to continue physical and occupational rehabilitation there.'''...

Hers was an exceptionally long time on ECMO-54 days-which is testament to the phenomenal nursing care she received that didn't result in any permanent complications," he said. The length of time on ECMO "is almost a record here and probably a record for someone with as good an outcome as she had. She may be coming back to work in a week." She was in fact cleared to return recently...

Of course, the big public message here is the importance of flu vaccines. Theiret and her husband, a drugstore manager, say they are newly committed to getting immunized to help prevent the ordeal they just experienced.

Specializes in Med/Surg, Academics.
Not sure about adult ECMO, but in the peds ICU, our ECMO patients cannot be 'turned'. We place them on pressure reduction surfaces, and every hour or two wiggle our hands beneath them to reduce pressure, but because of our patient's size relative to the size of the cannulas, turning could dislodge the catheter tip from their teeny tiny SVC/RAs.

54 days on ECMO - all I can say is wow!

Thanks for explaining this. I suspected it had to do with the complexities of ECMO access points, and your post confirmed it.

Specializes in Med/Surg, Academics.

Don't mean to derail, but I have to ask about BMs and nutrition while on ECMO. Anybody care to explain? TIA.

Wow... This article could have been written about my older brother! His story was almost exactly the same except he didn't have a fever, he had an unrelenting cough and was sent home from the clinic twice before being admitted. He was placed on a vent and two days later was started on ECMO and transferred to larger hospital 4 hours away. Sadly his story didn't have a happy ending, a week after he was placed on ECMO he developed a secondary infection that the MDs could not pinpoint and he went into multi-organ failure. He passed away in Feb. Last year was the first time he hadn't gotten his annual flu shot in years...

Specializes in SICU, trauma, neuro.

How horrible. I'm so very sorry for your loss!!

Wow... This article could have been written about my older brother! His story was almost exactly the same except he didn't have a fever, he had an unrelenting cough and was sent home from the clinic twice before being admitted. He was placed on a vent and two days later was started on ECMO and transferred to larger hospital 4 hours away. Sadly his story didn't have a happy ending, a week after he was placed on ECMO he developed a secondary infection that the MDs could not pinpoint and he went into multi-organ failure. He passed away in Feb. Last year was the first time he hadn't gotten his annual flu shot in years...
Specializes in NICU, ICU, PICU, Academia.
Don't mean to derail, but I have to ask about BMs and nutrition while on ECMO. Anybody care to explain? TIA.

In the PICU- we do not feed our ECMO patients- they are on TPN. And as for BMs- well, it takes three people to change a diaper when it's an ECMO patient sometimes! One person to mash down the mattress enough to get under it, on to clean and one to hold the cannulae. Our patients are under heavy sedation and usually neuromuscular blockade during the entire run.

Specializes in SICU, trauma, neuro.
Don't mean to derail, but I have to ask about BMs and nutrition while on ECMO. Anybody care to explain? TIA.

Disclaimer--I have had exactly 2 patients on ECMO during my career, so I am not the most experienced in this area. Both of them were at a hospital I worked at years ago. I have not seen anyone on it at my current hospital. I am not ECMO trained myself (yet); I was the regular RN, and with one pt I had a perfusionist and for the other I had an ECMO-trained RN with me. From what I understand it is used a lot more in peds than it is in adults because adults typically don't have good outcomes. It's kind of a last-ditch effort.

If the pt had a BM, we were able to logroll him with a CVTS physician present. We just couldn't position the pt side-to-side or otherwise let them move. My one was paralyzed and deeply sedated...the other I can't remember. I can't remember offhand if we paralyzed all of the ECMO pts or just the ones who tried to move around even w/ sedation. I think we might have had them positioned in reverse Trendelenberg so that they weren't completely flat, although we couldn't raise the HOB. The pts were tubefed, just like any ICU pt who's intubated and can't take PO nutrition.

um....... at my hospital we routinely walk our long term waiting for a heart or lung ECMO pt.s and we have had many that were there for MONTHS way more than 58 days lol. the youngest one we have walked on ECMO was four.

the expected to be short term ECMO patients however are kept sedated. risk vs reward

Hello all,

Well it's me!! ECMO girl 54days.

I have read all of your comments and I appreciate all thoughts and questions.

To answer some of the burning questions and concerns expressed here:

-Yes I did have AWESOME AWESOME nursing and medical care or else I would not be here today. (that an a helpful hand from the man upstairs:))I was so hypoxic that turning and repostioning was not an option for quite some time. My ARDS was so severe, hence ECMO for 54days, those of you who have cared for ECMO understand that this is abnormally long. I was sedated and paralyized fin exess of 8 weeks.

Also this wound was NOT on a normal pressure point it was right in the center of my back, so my best guess is either linen was bawled up under neath me, or a needle cap etc. I was a perfect set up for this as I was hypoxic, low albumin, protein, malnurished to a degree. AND I had NO OTHER AREAS OF BREAKDOWN- on my head, elbows, coccyx, or heals.

- ECMO is really a last ditch effort for ARDS. It is NOT something you would want your family or yourself to be on as an adult. Mortality is usually >90%. Once ECMO is established usually vent setting can be downgraded..not so in my case, I remained on pressure controlled ventilation, 100% FIo2, peep of 25, 40 ppm nitric oxide, AND 100% flow on ECMO for some time(YIKES)

-this is a therapy common in the pediatric population, but in adults not so much and outcomes usually not so successful and if they are pts usually have many complications (IE kidney failure, liver failure, clots, or major CNS event, bleeding,ischemic limbs etc.

-Yes many PRE op lung transplants are on a type of ECMO called Nuvo lung which enables them to be up and mobile in the hopes of increasing strength and overall constitution so that post op they do better. Difference is this: underlying cause of hypoxia is much different than in acute ARDS. they usually have one cannulation site in right IJ using Avalon catheter (that has 2 ports) which is much smaller than the larger cannula utilized here and they are NOT cannulated in the groins. ECMO in my case was very similar to heart lung bypass utilized in open heart surgery.

I endurred quite the ordeal, but I am happy to report I returned to work fulltime (I am also an RN) in September- 5 months following discharge from a 4 1/2 month hospital stay.

I continue with therapy and ongoing strengthening.

My wound was offically closed and healed in January- 1 yr after the start of this nightmare. (WIHTOUT surgery I may add)

I have been let with some residual pulmonary fibrosis, but considering were I was I am grateful and am now oxygen free:)

Life is great.

Thanks again for all the interest

T

Specializes in Complex pedi to LTC/SA & now a manager.
Hello all,

Well it's me!! ECMO girl 54days.

I have read all of your comments and I appreciate all thoughts and questions.

To answer some of the burning questions and concerns expressed here:

-Yes I did have AWESOME AWESOME nursing and medical care or else I would not be here today. (that an a helpful hand from the man upstairs:))I was so hypoxic that turning and repostioning was not an option for quite some time. My ARDS was so severe, hence ECMO for 54days, those of you who have cared for ECMO understand that this is abnormally long. I was sedated and paralyized fin exess of 8 weeks.

Also this wound was NOT on a normal pressure point it was right in the center of my back, so my best guess is either linen was bawled up under neath me, or a needle cap etc. I was a perfect set up for this as I was hypoxic, low albumin, protein, malnurished to a degree. AND I had NO OTHER AREAS OF BREAKDOWN- on my head, elbows, coccyx, or heals.

- ECMO is really a last ditch effort for ARDS. It is NOT something you would want your family or yourself to be on as an adult. Mortality is usually >90%. Once ECMO is established usually vent setting can be downgraded..not so in my case, I remained on pressure controlled ventilation, 100% FIo2, peep of 25, 40 ppm nitric oxide, AND 100% flow on ECMO for some time(YIKES)

-this is a therapy common in the pediatric population, but in adults not so much and outcomes usually not so successful and if they are pts usually have many complications (IE kidney failure, liver failure, clots, or major CNS event, bleeding,ischemic limbs etc.

-Yes many PRE op lung transplants are on a type of ECMO called Nuvo lung which enables them to be up and mobile in the hopes of increasing strength and overall constitution so that post op they do better. Difference is this: underlying cause of hypoxia is much different than in acute ARDS. they usually have one cannulation site in right IJ using Avalon catheter (that has 2 ports) which is much smaller than the larger cannula utilized here and they are NOT cannulated in the groins. ECMO in my case was very similar to heart lung bypass utilized in open heart surgery.

I endurred quite the ordeal, but I am happy to report I returned to work fulltime (I am also an RN) in September- 5 months following discharge from a 4 1/2 month hospital stay.

I continue with therapy and ongoing strengthening.

My wound was offically closed and healed in January- 1 yr after the start of this nightmare. (WIHTOUT surgery I may add)

I have been let with some residual pulmonary fibrosis, but considering were I was I am grateful and am now oxygen free:)

Life is great.

Thanks again for all the interest

T

Wow. Returned to work less than six months post discharge you must have had an excellent care team straight through plus wonderful support from family and colleagues. Thank you for taking the time to share your experience. I would not be surprised if it was a cap that initiated the pressure sore as I've seen that happen first hand sadly enough

Incredible! Thanks for the post :-)

Thx for the kind words

yes I had great care but I also worked

extremely hard

i had critical illness myopathy from all

the steroids sedation and immobility

i essentially was paralyzed

couldn't move my limbs stand walk sit

or anything

it was the hardest most painful process

atill not 100 % in terms of strength but

I'm still working on it

but I was determined

Specializes in Complex pedi to LTC/SA & now a manager.

I spent a week intubated on a vent with high dose steroids and heavy sedation from status asthmaticus. I couldn't sit up or barely swallow. I had to learn how to sit up and walk. I can't imagine over two months sedated. Still five months is still very impressive and shows your dedication towards recovery and wellness as well as hard work on your rehabilitation regime. One day at a time, one foot in front of the other and the strength will come to diminish the deconditioning. You are here talking with us and I am thankful you are here to share. Best wishes as you continue to get stronger

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