Department of Intensive Care, The First Hospital of China Medical University, Nanjing Bei Street 155, Shenyang, 110001, Liaoning Province, People's Republic of China.
Department of Intensive Care, Tacheng Hospital of China Medical University, Tacheng, China.
BMC Pulm Med. 2020 Feb 11;20(1):37. doi: 10.1186/s12890-020-1078-1.
Prolonged and difficult weaning is associated with higher rates of complications and mortality. Therefore, it is important to identify the associated factors.
We describe our experience with a 37-year-old man diagnosed with severe viral pneumonia (influenza A). He presented with acute respiratory failure type I on admission. During intubation, his blood pressure and heart rate decreased, and epinephrine and norepinephrine were administered. Although his clinical condition improved 8 days after intensive care unit (ICU) admission, he experienced difficulty weaning. He remained conscious but had a poor spontaneous cough with sputum production and weak limb muscle strength. His cough reflex was absent during bronchoscopic sputum suction, and he used abdominal breathing during the T-tube test. Magnetic resonance imaging revealed an Arnold-Chiari malformation type I, posterior dislocation of the odontoid process, and syringomyelia, with compression and deformation of the medulla and high cervical cord. The patient was successfully weaned from the ventilator at 20 days after ICU admission.
Arnold-Chiari malformation type I and posterior dislocation of the odontoid process, which aggravate medullary compression and increase the risk of cervical nerve injury, might be a rare factor affecting prolonged weaning in critical illness.
延长和困难的脱机与更高的并发症和死亡率相关。因此，识别相关因素很重要。
我们描述了一位 37 岁男性的经历，他被诊断患有严重病毒性肺炎（甲型流感）。他入院时表现为 I 型急性呼吸衰竭。在插管过程中，他的血压和心率下降，给予肾上腺素和去甲肾上腺素。尽管他在重症监护病房（ICU）入院 8 天后临床状况有所改善，但他出现脱机困难。他仍然有意识，但咳痰能力差，咳嗽反射消失，四肢肌肉力量较弱。在支气管镜吸痰时，他使用腹式呼吸，在 T 型管试验中。磁共振成像显示 I 型 Arnold-Chiari 畸形，齿状突后脱位，伴有延髓和高颈髓受压和变形。患者在 ICU 入院后 20 天成功脱机。
Arnold-Chiari 畸形 I 型和齿状突后脱位加重了延髓受压，增加了颈神经损伤的风险，可能是影响危重病患者延长脱机的罕见因素。
