The Pattern and Distribution of Ventilatory Defects after Extracorporeal Membrane Oxygenation in Survivors of Leptospirosis with Acute Respiratory Distress Syndrome: A Single-center Cross-sectional Study

Background and Objective. Pulmonary hemorrhage and acute respiratory distress syndrome (ARDS) are complications of severe leptospirosis with higher mortality rates. These are indications for initiating extracorporeal membrane oxygenation (ECMO). Given the improved survival of leptospirosis patients undergoing ECMO, little is known about the expected pulmonary function, including the presence and severity of possible ventilatory defects following these complications and intervention. This study aimed to determine the pattern and distribution of ventilatory defects in patients who underwent ECMO for severe leptospirosis with ARDS and survived.

Methods. This is a cross-sectional study that reviewed all patients who underwent ECMO for severe leptospirosis and ARDS at the National Kidney and Transplant Institute from its initiation in 2018 up to December 2021. The primary outcomes measured were the presence and severity of ventilatory defects by spirometry. Secondary outcomes included the clinical profile, laboratory findings, radiologic features, duration on mechanical ventilation, and duration on ECMO. Stata17 was used for data analysis.

Results. Among 14 patients meeting the inclusion criteria, 11 were male with a mean age of 30 years (SD, 6.2). Using spirometry, 13 had a restrictive ventilatory defect, while only 1 had a normal result. Of the 13 patients, 9 had mild disease, 2 each had moderate, and moderately severe disease. A lower platelet count, lower PaO2/FiO2 ratio (PFR), higher SOFA score, and longer duration of days on ECMO were noted in the group with ventilatory defect. Meanwhile, longer duration of days on mechanical ventilation (MV) and ECMO, higher procalcitonin, and higher APACHE-II scores were noted in patients with moderately severe restrictive ventilatory defect.

Conclusions. This study suggests that restrictive ventilatory defect may be seen among patients who survived severe leptospirosis and ARDS after undergoing ECMO.