Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
Respir Care. 2011 Oct;56(10):1611-3. doi: 10.4187/respcare.01147. Epub 2011 Apr 19.
We describe the case of a woman who presented to the intensive care unit with acute respiratory failure that required mechanical ventilation. She had severe pulmonary hypertension secondary to interstitial lung disease, and her history included sarcoidosis and tuberculosis. She was dependent on inhaled nitric oxide (INO) to maintain safe arterial oxygen saturation and could not be weaned from mechanical ventilation. Echocardiography revealed a patent foramen ovale with substantial right-to-left shunt, which probably contributed to her hypoxemia. Sildenafil enabled weaning from INO and substantially reduced the flow through the patent foramen ovale. She was successfully extubated and discharged home. To our knowledge, this is the first report of weaning from INO and mechanical ventilation in a patient with both severe secondary pulmonary hypertension and a right-to-left shunt through a patent foramen ovale.
我们描述了一位女性的病例，她因急性呼吸衰竭而入住重症监护病房，需要进行机械通气。她患有由间质性肺病引起的严重肺动脉高压，且有结节病和结核病病史。她依赖吸入一氧化氮（INO）来维持安全的动脉血氧饱和度，无法从机械通气中撤机。超声心动图显示卵圆孔未闭且存在大量右向左分流，这可能导致她出现低氧血症。西地那非使她能够从 INO 撤机，并且显著减少了卵圆孔未闭的分流。她成功拔管并出院回家。据我们所知，这是首例既有严重继发性肺动脉高压又有卵圆孔未闭右向左分流的患者从 INO 和机械通气中撤机的报告。
