Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
BMC Pulm Med. 2017 Jul 20;17(1):103. doi: 10.1186/s12890-017-0445-z.
To describe the experience of combination therapy with extracorporeal membrane oxygenation(ECMO), high-frequency oscillatory ventilation(HFOV) and prone positioning in treating severe respiratory failure caused by community acquired methicillin resistant Staphylococcus aureus(CA-MRSA).
A 30-year-old female presented with fever and dyspnea for 3 days. She was diagnosed CA-MRSA pneumonia complicated by severe respiratory failure, pneumothorax and neutropenia. Venovenous ECMO was applied within 8 h of the pneumothorax diagnosis. For amelioration of ventilator-induced lung injury, HFOV and prone positioning were combined with ECMO. The patient's condition improved considerably. ECMO was weaned on day 19, and she was discharged on day 48 with good lung recovery.
To the best of our knowledge, this was the first case in which ECMO was combined with HFOV and prone positioning to treat severe necrotic CA-MRSA pneumonia complicated with pneumothorax. This combination therapy may provide safe respiratory support, may minimize the risk of barotrauma, and provide better drainage of secretions in patients with necrotizing pneumonia.
描述体外膜氧合（ECMO）、高频振荡通气（HFOV）和俯卧位通气联合治疗社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）引起的严重呼吸衰竭的经验。
一名 30 岁女性因发热和呼吸困难 3 天就诊。她被诊断为 CA-MRSA 肺炎并发严重呼吸衰竭、气胸和中性粒细胞减少症。气胸诊断后 8 小时内应用了静脉-静脉 ECMO。为了改善呼吸机引起的肺损伤，在 ECMO 中联合应用 HFOV 和俯卧位通气。患者的病情明显改善。第 19 天撤机 ECMO，第 48 天肺功能恢复良好出院。
据我们所知，这是首例 ECMO 联合 HFOV 和俯卧位通气治疗伴有气胸的严重坏死性 CA-MRSA 肺炎的病例。这种联合治疗可能为患者提供安全的呼吸支持，最大限度地降低气压伤风险，并为坏死性肺炎患者提供更好的分泌物引流。
