Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.
Respir Care. 2012 Feb;57(2):293-7. doi: 10.4187/respcare.01290. Epub 2011 Jul 12.
Idiopathic interstitial pneumonia frequently causes severe pulmonary restriction that in turn makes mechanical ventilation difficult. We report the case of a 44-year-old woman who developed a refractory severe hypercapnic respiratory failure (P(aCO(2)) 281 mm Hg, pH 6.77) despite mechanical ventilation with high inspiratory pressure and PEEP. A pumpless extracorporeal lung assist device, Novalung, was used as rescue therapy for carbon dioxide removal, enabling lung-protective ventilation and normalization of life-threatening acidosis. Open lung biopsy revealed an idiopathic interstitial pneumonia with histological features of a nonspecific interstitial pneumonia. Corticosteroid therapy led to progressive improvement of pulmonary function, soon permitting cessation of mechanical ventilation and extracorporeal therapy. The patient was discharged from the intensive care unit after 20 days. This case demonstrates the successful use of pumpless extracorporeal lung assist as an alternative device to pump-driven extracorporeal membrane oxygenation in severe hypercapnic respiratory failure secondary to nonspecific interstitial pneumonia.
特发性间质性肺炎常导致严重的肺限制，进而使机械通气变得困难。我们报告了一例 44 岁女性的病例，她在机械通气中出现高吸气压力和 PEEP 仍无法纠正的难治性严重高碳酸血症性呼吸衰竭（P(aCO(2)) 281mmHg，pH 6.77）。使用无泵体外肺辅助装置 Novalung 作为二氧化碳清除的抢救治疗，能够进行肺保护性通气并纠正危及生命的酸中毒。开胸肺活检显示特发性间质性肺炎，具有非特异性间质性肺炎的组织学特征。皮质类固醇治疗导致肺功能逐渐改善，很快可以停止机械通气和体外治疗。患者在 20 天后从重症监护病房出院。该病例表明，在继发于非特异性间质性肺炎的严重高碳酸血症性呼吸衰竭中，无泵体外肺辅助可作为泵驱动体外膜氧合的替代设备。
