Gonçalves-Venade Gabriela, Lacerda-Príncipe Nuno, Roncon-Albuquerque Roberto, Paiva José Artur
Department of Emergency and Intensive Care Medicine, Centro Hospitalar S. João, Porto, Portugal.
Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
Artif Organs. 2018 May;42(5):569-574. doi: 10.1111/aor.13075. Epub 2018 Jan 11.
Acute interstitial pneumonia (AIP) is a rare idiopathic interstitial lung disease with rapid progressive respiratory failure and high mortality. In the present report, three cases of AIP complicated by refractory respiratory failure supported with extracorporeal membrane oxygenation (ECMO) are presented. One male and two female patients (ages 27-59) were included. Venovenous ECMO support was provided using miniaturized systems, with two-site femoro-jugular circuit configuration. Despite lung protective ventilation, prone position and neuromuscular blockade, refractory respiratory failure of unknown etiology supervened (ratio of arterial oxygen partial pressure to fractional inspired oxygen 46-130) and ECMO was initiated after 3-7 days of mechanical ventilation. AIP diagnosis was established after exclusion of infectious and noninfectious acute respiratory distress syndrome on the basis of clinical and analytical data, bronchoalveolar lavage analysis and lung imaging, with a confirmatory surgical lung biopsy revealing diffuse alveolar damage of unknown etiology. Immunosuppressive treatment consisted in high-dose corticosteroids and cyclophosphamide in one case. Two patients survived to hospital discharge. ECMO allowed AIP diagnosis and treatment in the presence of refractory respiratory failure, therefore reducing ventilator-induced lung injury and bridging lung recovery in two patients. ECMO referral should be considered in refractory respiratory failure if AIP is suspected.
急性间质性肺炎（AIP）是一种罕见的特发性间质性肺疾病，具有快速进展的呼吸衰竭且死亡率高。在本报告中，介绍了3例AIP合并难治性呼吸衰竭并接受体外膜肺氧合（ECMO）支持的病例。包括1例男性和2例女性患者（年龄27 - 59岁）。使用小型化系统提供静脉 - 静脉ECMO支持，采用双部位股静脉 - 颈内静脉回路配置。尽管采用了肺保护性通气、俯卧位和神经肌肉阻滞，仍出现了病因不明的难治性呼吸衰竭（动脉血氧分压与吸入氧分数比为46 - 130），并在机械通气3 - 7天后启动了ECMO。在根据临床和分析数据、支气管肺泡灌洗分析及肺部影像学排除感染性和非感染性急性呼吸窘迫综合征后，确立了AIP诊断，确诊性手术肺活检显示病因不明的弥漫性肺泡损伤。1例患者的免疫抑制治疗包括大剂量皮质类固醇和环磷酰胺。2例患者存活至出院。ECMO使得在难治性呼吸衰竭的情况下能够对AIP进行诊断和治疗，从而减少了呼吸机诱导的肺损伤，并使2例患者的肺得以恢复。如果怀疑AIP导致难治性呼吸衰竭，应考虑转诊至ECMO治疗。
