High K M, Snider M T, Richard R, Russell G B, Stene J K, Campbell D B, Aufiero T X, Thieme G A
Department of Anesthesia, Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University, Hershey 17033.
Anesthesiology. 1992 Nov;77(5):856-63. doi: 10.1097/00000542-199211000-00004.
In patients with severe adult respiratory distress syndrome, mechanical ventilation may not be able to ensure gas exchange sufficient to sustain life. We report the use of an intravenous oxygenator (IVOX) in five patients who were suffering from severe adult respiratory distress syndrome as a result of aspiration, fat embolism, or pneumonia. IVOX was used in an attempt to provide supplemental transfer of CO2 and O2 and thereby reduce O2 toxicity and barotrauma. All patients were tracheally intubated, sedated, and chemically paralyzed and had a PaO2 < 60 mmHg when the lungs were ventilated with an FIO2 = 1.0 and a positive end expiratory pressure of > or = 5 cmH2O. The right common femoral vein was located surgically, and the patient was systemically anticoagulated with heparin. A hollow introducer tube was inserted into the right common femoral vein, and the furled IVOX was passed into the inferior vena cava and advanced until the tip was in the lower portion of the superior vena cava. IVOX use ranged from 2 h to 4 days. In this group of patients, IVOX gas exchange ranged from 21 to 87 ml x min-1 of CO2 and from 28 to 85 ml x min-1 of O2. One of the five patients survived and was discharged from the hospital. The IVOX transferred up to 28% of metabolic gas-exchange requirements. One patient with a small vena cava showed signs of caval obstruction. Three other patients demonstrated signs of a septic syndrome after the device was inserted.(ABSTRACT TRUNCATED AT 250 WORDS)
在患有严重成人呼吸窘迫综合征的患者中，机械通气可能无法确保有足够的气体交换以维持生命。我们报告了对5例因误吸、脂肪栓塞或肺炎而患有严重成人呼吸窘迫综合征的患者使用静脉内氧合器（IVOX）的情况。使用IVOX的目的是提供二氧化碳和氧气的补充交换，从而降低氧中毒和气压伤。所有患者均经气管插管、镇静并使用化学麻痹剂，当以1.0的吸入氧分数和大于或等于5 cmH₂O的呼气末正压通气时，其动脉血氧分压（PaO₂）<60 mmHg。通过外科手术找到右股总静脉，并用肝素对患者进行全身抗凝。将一根空心导入管插入右股总静脉，将卷起的IVOX送入下腔静脉并推进，直到其尖端位于上腔静脉下部。IVOX的使用时间为2小时至4天。在这组患者中，IVOX的气体交换量为二氧化碳21至87 ml·min⁻¹，氧气28至85 ml·min⁻¹。5例患者中有1例存活并出院。IVOX满足了高达28%的代谢气体交换需求。1例下腔静脉较小的患者出现了腔静脉阻塞的迹象。另外3例患者在插入该装置后出现了败血症综合征的迹象。（摘要截短至250字）
