Maqsood Usman, Patel Nehal
Respiratory Medicine, Royal Stoke University Hospital, Stoke on Trent, UK.
Critical Care Unit, Royal Stoke University Hospital, Stoke on Trent, UK.
BMJ Case Rep. 2018 Mar 20;2018:bcr-2017-223276. doi: 10.1136/bcr-2017-223276.
We describe a case of near-fatal asthma, treated successfully by initiation of extracorporeal membrane oxygenation (ECMO). A 29-year-old woman, known asthmatic on steroid inhalers, inhaled/nebulised bronchodilators, long-term oral prednisolone, theophylline and montelukast, presented with acute shortness of breath. She deteriorated following initial treatment with nebulised bronchodilators and magnesium sulfate requiring intubation and mechanical ventilation. Severe bronchospasm ensued following mechanical ventilation and peak airway pressures remained at 55 cm HO with intrinsic positive end expiratory pressure(PEEP) of 14 cm HO. Despite treatment with sedation, paralysis, intravenous salbutamol and inhaled sevoflurane, her condition deteriorated. She was commenced on mobile ECMO by the retrieval team. While on ECMO, her CO normalised within 48 hours. She was extubated within 72 hours of initiating ECMO and was discharged to the ward next day. We reiterate that ECMO should be considered sooner for status asthmatics not responding to maximal pharmacological therapy and ventilatory support to prevent ongoing lung injury and mortality.
我们描述了一例通过启动体外膜肺氧合（ECMO）成功治疗的濒死哮喘病例。一名29岁女性，已知患有哮喘，使用类固醇吸入器、吸入/雾化支气管扩张剂、长期口服泼尼松龙、茶碱和孟鲁司特，出现急性呼吸急促。她在接受雾化支气管扩张剂和硫酸镁初始治疗后病情恶化，需要插管和机械通气。机械通气后出现严重支气管痉挛，气道峰值压力维持在55 cm H₂O，内在呼气末正压（PEEP）为14 cm H₂O。尽管使用了镇静、麻痹、静脉注射沙丁胺醇和吸入七氟醚治疗，她的病情仍恶化。转运团队为她启动了可移动ECMO。在使用ECMO期间，她的心输出量在48小时内恢复正常。在启动ECMO后72小时内她拔除了气管插管，第二天出院。我们重申，对于对最大药物治疗和通气支持无反应的哮喘持续状态患者，应尽早考虑使用ECMO，以防止持续的肺损伤和死亡。
