使用无泵体外肺辅助和神经调节通气支持成功治疗一名来自阿富汗的重伤士兵。
Successful treatment of a severely injured soldier from Afghanistan with pumpless extracorporeal lung assist and neurally adjusted ventilatory support.
作者信息
Bein Thomas, Osborn Eric, Hofmann Hans Stefan, Zimmermann Markus, Philipp Alois, Schlitt Hans J, Graf Bernhard M
出版信息
Int J Emerg Med. 2010 Jul 13;3(3):177-9. doi: 10.1007/s12245-010-0192-x.
BACKGROUND
Life-threatening acute lung injury due to combat and/or terror attacks is associated with high mortality. The successful management includes the use of "rescue" extracorporeal lung assist and early transport by aeromedical evacuation teams.
AIMS
Description of the pre-hospital support of a severely injured soldier with a pumpless extracorporeal arterio-venous lung assist in critical hypercapnia/hypoxemia.
METHOD
A British soldier suffered from severe gunshot injuries to the chest and abdomen in Afghanistan. After traumatic pneumonectomy, he developed critical hypercapnia/hypoxemia. He was mechanically ventilated and supported with a pumpless interventional extracorporeal lung assist (iLA, Novalung, Talheim, Germany) and transferred to Germany.
RESULTS
A sufficient CO(2) extraction and improvement in oxygenation enabled the safe transportation and lung protective ventilation. Weaning from mechanical ventilation was promoted by the application of a new neurally adjusted ventilatory assist (NAVA). The patient recovered, and he left Germany in stable condition.
CONCLUSION
Novel techniques in extracorporeal lung assist and in ventilatory support may help save lives even in disaster medicine.
背景
由战斗和/或恐怖袭击导致的危及生命的急性肺损伤死亡率很高。成功的治疗包括使用“救援”体外肺辅助以及由空中医疗后送团队进行早期转运。
目的
描述一名严重受伤士兵在严重高碳酸血症/低氧血症时使用无泵体外动静脉肺辅助进行院前支持的情况。
方法
一名英国士兵在阿富汗胸部和腹部遭受严重枪伤。创伤性肺切除术后，他出现严重高碳酸血症/低氧血症。对其进行机械通气，并使用无泵介入性体外肺辅助（iLA，德国塔海姆的诺瓦隆公司）进行支持，然后转运至德国。
结果
充分的二氧化碳清除和氧合改善使得安全转运和肺保护性通气成为可能。应用一种新的神经调节通气辅助（NAVA）促进了机械通气的撤离。患者康复，出院时情况稳定。
结论
体外肺辅助和通气支持方面的新技术即使在灾难医学中也可能有助于挽救生命。
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