Madurka Ildikó, Bartók Tibor, Kormosói-Tóth Krisztina, Schönauer Nóra, Elek Jenő, Bobek Ilona
Aneszteziológiai és Intenzív Terápiás Osztály, Országos Onkológiai Intézet Budapest, Ráth Gy. u. 7-9., 1122.
Központi Aneszteziológiai és Intenzív Betegellátó Osztály, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet Budapest.
Orv Hetil. 2019 Feb;160(6):235-240. doi: 10.1556/650.2019.31285.
The mortality of severe ARDS is almost 60%. Ventilation-associated lung-injury can be avoided by low-pressure, low-volume ventilation. Potential use of ECMO in case of refractory hypoxemia beside modern ventilatory therapy can be considered. Increasing numbers of respiratory ECMO runs are seen worldwide, though the efficacy remains controversial. The authors present the first successful venovenous-ECMO treatment in severe ARDS in our Institute. We report the case of a 67-year-old male who was admitted with community-acquired pneumonia caused by Legionella. Despite empirical and later targeted antibiotic therapy, severe ARDS with sepsis evolved. Neither ventilation nor prone position resulted in permanent improvement in oxygenation. The patient was referred to our Institute for extracorporeal life support (ECLS) therapy. On admission, blood gas showed severe hypoxemia with mild hypercapnia (PaO/FiO: 60, pCO: 53 mmHg at PEEP: 14 mmHg, PIP: 45 mmHg). X-ray showed bilateral patchy infiltrates while cardiac impairment (EF: 45%) and dilated right ventricle were seen on echocardiography. Elevated pulmonary artery pressure (mPAP: 41 mmHg) was measured. After implantation of femoral-jugular VV ECMO, oxygen saturation was appropriate with lung protective ventilation (FiO: 0.5, TV: 3-4 ml/kg). Improving lung function enabled us to stop ECMO after 8 days and further 5 days later the patient was weaned off ventilation. After 21 days of intensive care we discharged him to the referral hospital. By reporting this case we emphasise the potential role of respiratory ECMO. Consideration should be given to increase the contingent of this modality in the Hungarian intensive care in accordance with international practice. Orv Hetil. 2019; 160(6): 235-240.
重症急性呼吸窘迫综合征（ARDS）的死亡率近60%。可通过低压、小潮气量通气避免呼吸机相关性肺损伤。在现代通气治疗之外，对于难治性低氧血症可考虑使用体外膜肺氧合（ECMO）。尽管其疗效仍存在争议，但全球范围内接受呼吸ECMO治疗的患者数量在不断增加。本文作者报告了我院首例成功应用静脉-静脉ECMO治疗重症ARDS的病例。我们报道了一名67岁男性患者，因军团菌引起的社区获得性肺炎入院。尽管给予了经验性及后续的针对性抗生素治疗，但仍进展为伴有脓毒症的重症ARDS。通气及俯卧位均未能使氧合得到持久改善。该患者被转至我院接受体外生命支持（ECLS）治疗。入院时，血气分析显示严重低氧血症伴轻度高碳酸血症（在呼气末正压通气[PEEP]为14 mmHg、气道峰压[PIP]为45 mmHg时，动脉血氧分压[PaO₂]/吸入氧分数值[FiO₂]为60，二氧化碳分压[pCO₂]为53 mmHg）。胸部X线显示双侧斑片状浸润影，超声心动图显示心脏功能受损（射血分数[EF]为45%）及右心室扩张。测得肺动脉压升高（平均肺动脉压[mPAP]为41 mmHg）。植入股静脉-颈内静脉VV ECMO后，在肺保护性通气（FiO₂为0.5，潮气量[TV]为3 - 4 ml/kg）情况下氧饱和度适宜。肺功能改善使我们能够在8天后停用ECMO，再过5天患者脱机。经过21天的重症监护，我们将他转至转诊医院。通过报道该病例，我们强调了呼吸ECMO的潜在作用。应根据国际惯例，考虑在匈牙利重症监护中增加这种治疗方式的使用量。《匈牙利医学周报》。2019年；160(6): 235 - 240。
