Mikkelsen Mark E, Pugh Meredith E, Hansen-Flaschen John H, Woo Y Joseph, Sager Jeffrey S
Division of Pulmonary, Allergy, and Critical Care , Hospital of the University of Pennsylvania, 836 W Gates Pavilion, Philadelphia, PA 19104, USA.
Respir Care. 2007 Nov;52(11):1525-9.
We report a case of successful use of extracorporeal life support (ECLS) as salvage treatment in an adult with acute, severe, reversible respiratory failure due to asphyxic status asthmaticus. Conventional measures were ineffective to combat the dynamic hyperinflation; the patient had intrinsic positive end-expiratory pressure > 30 cm H(2)O. We initiated emergency ECLS at the bedside, and after 55 hours of ECLS his respiratory mechanics had markedly improved and he was subsequently weaned off of ECLS and decannulated, without vascular, pulmonary, or neurologic complications. This article reviews the history of ECLS for adult respiratory failure and its application for life-threatening status asthmaticus. This case illustrates the effective use of ECLS for acute respiratory failure due to asphyxic status asthmaticus, and to our knowledge is the first reported case in which the patient's impending cardiopulmonary arrest was due to an unsustainable level of intrinsic positive end-expiratory pressure.
我们报告了一例成功使用体外生命支持（ECLS）作为抢救治疗手段的案例，该成年患者因窒息性哮喘状态导致急性、严重、可逆性呼吸衰竭。传统措施无法有效对抗动态肺过度充气；患者的内源性呼气末正压>30 cm H₂O。我们在床边启动了紧急ECLS，经过55小时的ECLS治疗，他的呼吸力学显著改善，随后成功脱机并拔除导管，未出现血管、肺部或神经系统并发症。本文回顾了ECLS用于成人呼吸衰竭的历史及其在危及生命的哮喘状态中的应用。该病例说明了ECLS在因窒息性哮喘状态导致的急性呼吸衰竭中的有效应用，据我们所知，这是首例报告的患者即将发生心肺骤停是由于内源性呼气末正压水平无法维持的病例。
