Aravantagi Avinash, Patra Kamakshya P, Shekar Suman, Scott L Keith
Critical Care Division, Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
Indian J Crit Care Med. 2011 Oct;15(4):224-6. doi: 10.4103/0972-5229.92078.
Status asthmaticus unresponsive to pharmacotherapy is conventionally managed with mechanical ventilation, which has its inherent challenges due to barotrauma, dynamic hyperinflation and autopositive end-expiratory pressure (auto-PEEP). Extracorporeal membrane oxygenation has been used as a last resort in respiratory failure due to refractory asthma; however, it entails many complications. In contrast, arteriovenous carbon dioxide removal (AVCO(2)R) is a novel strategy that has been shown to be highly effective in adults with acute respiratory failure. Only one pediatric case series of pediatric asthma managed with AVCO(2)R have been published so far. We herein report a case of severe asthma in a 9-year-old boy who developed severe hypercapnia (Pco2 97 mmHg) and acidosis (pH 7.09) despite being on mechanical ventilation. Within 4 h of initiation of AVCO(2)R, PCo(2) drastically reduced to near-normal levels. He was discharged on day 9 of hospital stay without any complications.
对药物治疗无反应的哮喘持续状态通常采用机械通气进行管理，由于气压伤、动态肺过度充气和内源性呼气末正压（auto-PEEP），机械通气存在其固有的挑战。体外膜肺氧合已被用作治疗难治性哮喘所致呼吸衰竭的最后手段；然而，它会带来许多并发症。相比之下，动静脉二氧化碳清除（AVCO₂R）是一种新策略，已被证明对成人急性呼吸衰竭非常有效。迄今为止，仅发表了一篇关于用AVCO₂R治疗儿童哮喘的儿科病例系列。我们在此报告一例9岁男孩的严重哮喘病例，尽管接受了机械通气，但仍出现严重高碳酸血症（Pco₂ 97 mmHg）和酸中毒（pH 7.09）。在开始AVCO₂R治疗后4小时内，PCo₂急剧降至接近正常水平。他在住院第9天出院，没有任何并发症。
