Schneider Thomas-Michael, Bence Tibor, Brettner Franz
Department of intensive care medicine, Krankenhaus Barmherzige Brueder Munich, Muenchen, Germany.
J Intensive Care. 2017 Aug 8;5:53. doi: 10.1186/s40560-017-0247-7. eCollection 2017.
Near-fatal asthma attacks are life threatening events that often require mechanical ventilation. Extracorporeal carbon dioxide removal (ECCOR) is, beside extracorporeal membrane oxygenation (ECMO), a well-established rescue option whenever ventilation gets to its limits. But there seems to be very rare experience with those techniques in avoiding mechanical ventilation in severe asthma attacks.
A 67-year-old man with a near-fatal asthma attack deteriorated under non-invasive ventilation conditions. Beside pharmacological treatment, the intensivists decided to use an extracorporeal carbon dioxide removal system (ECCOR) to avoid sedation and intubation. Within only a few hours, there was a breakthrough and the patient's status improved continuously. One and a half days later, weaning from ECCOR was already completed.
The discussion deals with several advantages of extracorporeal lung support in acute asthma, the potential of avoiding intubation and sedation, as well as the benefits of a conscious and spontaneously breathing patient. Extracorporeal membrane oxygenation (ECMO) in general and ECCOR in particular is a highly effective method for the treatment of an acute near-fatal asthma attack. Pathophysiological aspects favor the "awake" approach, without sedation, intubation, and mechanical ventilation. Therefore, experienced clinicians might consider "awake" ECCOR in similar cases.
近乎致命的哮喘发作是危及生命的事件，通常需要机械通气。除体外膜肺氧合（ECMO）外，体外二氧化碳清除（ECCOR）是在通气达到极限时一种成熟的救援选择。但在严重哮喘发作中使用这些技术避免机械通气的经验似乎非常罕见。
一名67岁近乎致命哮喘发作的男性在无创通气条件下病情恶化。除药物治疗外，重症监护医生决定使用体外二氧化碳清除系统（ECCOR）以避免镇静和插管。仅在数小时内就出现了转机，患者病情持续改善。一天半后，已完成ECCOR撤机。
讨论了体外肺支持在急性哮喘中的几个优点，避免插管和镇静的可能性，以及清醒且自主呼吸患者的益处。一般而言，体外膜肺氧合（ECMO），特别是ECCOR，是治疗急性近乎致命哮喘发作的高效方法。病理生理学方面支持“清醒”方法，无需镇静、插管和机械通气。因此，经验丰富的临床医生在类似病例中可能会考虑“清醒”ECCOR。
