Krawiec Conrad, Ballinger Ken, Halstead E Scott
Department of Pediatrics, Division of Pediatric Critical Care Medicine, Penn State University College of Medicine, Hershey, PA, USA.
Penn State Health Respiratory Care and Pulmonary Diagnostics, Penn State Health Children's Hospital, Hershey, PA, USA.
Front Pediatr. 2017 Apr 27;5:99. doi: 10.3389/fped.2017.00099. eCollection 2017.
Initiation of extracorporeal life support (ECLS) is often followed by complete opacification of pulmonary parenchyma and volume loss. The optimal mechanical ventilator management and lung recruitment strategy of a pediatric patient requiring extracorporeal membrane oxygenation is not known. We present a case of a 4-week old infant who developed a severe pertussis infection requiring ECLS. The severity of his illness and pertussis infection-associated intraluminal bronchiole obstruction made medical management challenging. In addition to lung protection ventilator strategies and bronchoscopy, intrapulmonary percussive ventilation was initiated to facilitate lung recruitment. This was associated with precipitous incremental improvement in lung compliance and eventual liberation from venoarterial ECLS.
体外生命支持（ECLS）启动后，肺实质通常会完全浑浊并出现容积减少。对于需要体外膜肺氧合的儿科患者，最佳的机械通气管理和肺复张策略尚不清楚。我们报告一例4周大的婴儿，因严重百日咳感染需要ECLS。其病情的严重程度以及百日咳感染相关的管腔内细支气管阻塞使医疗管理具有挑战性。除了肺保护通气策略和支气管镜检查外，还启动了肺内冲击通气以促进肺复张。这与肺顺应性的急剧渐进改善以及最终从静脉-动脉ECLS中脱机有关。
