Smiechowicz Jakub, Barteczko Barbara, Grotowska Małgorzata, Kaiser Teresa, Zieliński Stanisław, Kübler Andrzej
Department of Anaesthesiology and Intensive Therapy, Wrocław Medical University,Wrocław.
Anestezjol Intens Ter. 2011 Apr-Jun;43(2):98-103.
The influenza pandemic of 2009 was reported to be frequently associated with pulmonary complications, including ARDS. We report the case of a morbidly obese, 37-year-old, AH1N1-infected woman, who was admitted to a regional hospital because of rapidly progressing respiratory failure. She was treated successfully with high frequency oscillatory ventilation (HFOV) and low-flow extracorporeal CO2 removal.
The patient was admitted to a regional hospital because of severe viral infection, diabetes and hypertension that developed during pregnancy. On admission, she was deeply unconscious (GCS 5), hypotonic and anuric. Conventional ventilation, veno-venous haemofiltration, antibiotics and antiviral therapy (oseltamivir) did not improve the patient's condition, and she was transferred to a tertiary referral centre. Immediately before the transfer, she suffered two cardiac arrest episodes. They were successfully reversed. On admission, the patient was hypercapnic (PaCO2 150 mm Hg/20 kPa), acidotic (pH 6.92) and hyperkinetic (HR 120 min-1, CO 12.7 L min-1). Total lung compliance was 21 mL cm H2O-1, and SAP/DAP was 63/39 mm Hg). The PaO2/FIO2 index was 85. HFOV was instituted for 48 h, resulting in a marked improvement in gas exchange, however any manipulations caused immediate deterioration in the patient's condition. Extracorporeal CO2 removal was commenced and continued for 120 h, resulting in gradual improvement and eventual weaning from artificial ventilation after 17 days. Further treatment was complicated by septic shock due to Pseudomonas aeruginosa infection of the vagina, treated with piperacillin/tazobactam. The patient eventually recovered and returned to her regional hospital after 24 days.
During the 2009 pandemic, a high number of pulmonary complications were observed all over the world. Viral infections are especially difficult to treat and the CESAR study indicated that the use of ECMO or extracorporeal CO2 removal devices may result in a lower mortality when compared with standard therapy. We conclude that the use of a simple CO2 removal device can be beneficial in complicated cases of AH1N1 influenza.
据报道，2009年流感大流行常伴有肺部并发症，包括急性呼吸窘迫综合征（ARDS）。我们报告一例37岁的肥胖甲型H1N1感染女性病例，该患者因快速进展的呼吸衰竭入住一家地区医院。她通过高频振荡通气（HFOV）和低流量体外二氧化碳清除治疗成功康复。
该患者因孕期出现的严重病毒感染、糖尿病和高血压入住一家地区医院。入院时，她深度昏迷（格拉斯哥昏迷评分5分）、肌张力减退且无尿。常规通气、静脉-静脉血液滤过、抗生素和抗病毒治疗（奥司他韦）均未改善患者病情，随后她被转至一家三级转诊中心。就在转院之前，她发生了两次心脏骤停，均成功逆转。入院时，患者存在高碳酸血症（动脉血二氧化碳分压150 mmHg/20 kPa）、酸中毒（pH 6.92）和心动过速（心率120次/分钟，心输出量12.7 L/分钟）。肺总顺应性为21 mL/cmH₂O⁻¹，收缩压/舒张压为63/39 mmHg。动脉血氧分压/吸入氧分数值为85。进行高频振荡通气48小时，气体交换显著改善，但任何操作都会导致患者病情立即恶化。开始进行体外二氧化碳清除并持续120小时，病情逐渐改善，17天后最终脱离人工通气。进一步治疗因阴道铜绿假单胞菌感染导致的感染性休克而复杂化，使用哌拉西林/他唑巴坦进行治疗。患者最终康复，24天后返回其所在地区医院。
在2009年大流行期间，世界各地观察到大量肺部并发症。病毒感染尤其难以治疗，而CESAR研究表明，与标准治疗相比，使用体外膜肺氧合（ECMO）或体外二氧化碳清除装置可能降低死亡率。我们得出结论，在甲型H1N1流感复杂病例中使用简单的二氧化碳清除装置可能有益。
