Tanaka Hiroyuki, Nishiyama Kei, Shime Nobuaki
Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, 612-8555, Kyoto, Japan.
Department of Emergency and Critical Care Medicine, Hiroshima University, Hiroshima, Japan.
J Med Case Rep. 2017 Aug 11;11(1):220. doi: 10.1186/s13256-017-1381-5.
Extracorporeal membrane oxygenation is an established life-saving procedure for severe acute respiratory failure due to various causes. In general, the duration of extracorporeal membrane oxygenation ranges from 1 to 2 weeks, with withdrawal recommended if no improvement is noted. We report a successful case of long-term extracorporeal membrane oxygenation management for respiratory failure due to invasive pulmonary Aspergillus infection.
A 64-year-old Asian man with no previous underlying medical conditions was transferred to our hospital for fever and dyspnea. On admission, he presented with bilateral diffuse infiltration shadow on X-ray and chest computed tomography readings, and severe hypoxemia with a partial pressure of oxygen in arterial blood/fraction of inspired oxygen ratio of 55. He was intubated and underwent mechanical ventilation. A bronchial-alveolar lavage was performed prior to administration of antibiotics, and as the bacterial culture was positive for Aspergillus fumigatus, antifungal treatment was then initiated. His respiratory status deteriorated on the 11th admission day, with no improvement on any mechanical ventilator settings. Venous-venous extracorporeal membrane oxygenation was introduced. Extracorporeal membrane oxygenation was used for an extended period of time, with respiratory improvement delayed until the 39th admission day. Extracorporeal membrane oxygenation discontinuation was possible on the 44th day, and he was removed from the ventilator on the 64th day.
Long-term extracorporeal membrane oxygenation might be considered if the primary causes of respiratory failure necessitating extracorporeal membrane oxygenation can be expected to be resolved, such as in the case of effective antimicrobial therapy for a definite pathogen. Our case indicates that extracorporeal membrane oxygenation can be used during treatment of respiratory failure due to invasive aspergillosis for the recommended treatment duration of 4 to 8 weeks.
体外膜肺氧合是治疗各种原因导致的严重急性呼吸衰竭的一种成熟的挽救生命的方法。一般来说，体外膜肺氧合的持续时间为1至2周，如果没有改善则建议撤机。我们报告了一例因侵袭性肺曲霉感染导致呼吸衰竭的长期体外膜肺氧合管理成功病例。
一名64岁的亚洲男性，既往无基础疾病，因发热和呼吸困难转入我院。入院时，胸部X线和计算机断层扫描显示双侧弥漫性浸润影，动脉血氧分压/吸入氧分数比为55，存在严重低氧血症。他接受了气管插管并进行机械通气。在使用抗生素之前进行了支气管肺泡灌洗，由于曲霉菌培养阳性，随后开始抗真菌治疗。入院第11天，他的呼吸状况恶化，任何机械通气设置均无改善。于是采用了静脉-静脉体外膜肺氧合。体外膜肺氧合使用了较长时间，呼吸改善延迟至入院第39天。第44天可以停止体外膜肺氧合治疗，第64天他脱离了呼吸机。
如果需要体外膜肺氧合的呼吸衰竭的主要原因有望得到解决，例如针对明确病原体的有效抗菌治疗，那么可以考虑长期使用体外膜肺氧合。我们的病例表明，在侵袭性曲霉病导致的呼吸衰竭治疗中，体外膜肺氧合可在推荐的4至8周治疗期间使用。
