Schmauss M, Müller E, Schwamborn M, Giesa C, Ewig S
Klinik für Anästhesiologie, Intensiv-, Notfall- und Schmerzmedizin, EVK Herne, Herne.
Thoraxzentrum Ruhrgebiet, Klink für Innere Medizin, Pneumologie und Infektiologie, EVK Herne, Herne.
Pneumologie. 2020 Jul;74(7):423-428. doi: 10.1055/a-1199-2167. Epub 2020 Jul 16.
We report the case of a 60-year old female patient with advanced severe lung injury as a consequence of COVID-19-pneumonia. The patient was initially treated with highflow oxygen via nasal cannula (HFNC) and CPAP for two days but had to be intubated and mechanically ventilated. After failure of mechanical ventilation because of persistant severe hypoxemia treatment was switched to ECMO which was applicated for 24 days. Prognostic parameters indicated a favourable trend after day 14. After discontinuation of ECMO and 11 days of intermittent assisted ventilation via tracheostoma and low dose oxygen (1 l/min), the patient could be transferred to rehabilitation. The last chest radiograph prior to transferral revealed a nearly complete resolution of bilateral pulmonary infiltrates. Our case demonstrates that severe COVID-19-associated lung injury can be reversible even after prolonged ECMO.
我们报告了一例60岁女性患者，因新型冠状病毒肺炎导致晚期严重肺损伤。患者最初通过鼻导管高流量吸氧（HFNC）和持续气道正压通气（CPAP）治疗了两天，但随后不得不进行气管插管和机械通气。由于持续严重低氧血症，机械通气失败后，治疗改为体外膜肺氧合（ECMO），应用了24天。预后参数显示第14天后有良好趋势。停用ECMO并通过气管造口进行11天间歇性辅助通气和低剂量吸氧（1升/分钟）后，患者可转至康复治疗。转院之前的最后一次胸部X光片显示双侧肺部浸润几乎完全消退。我们的病例表明，即使经过长时间的ECMO治疗，严重的新型冠状病毒肺炎相关肺损伤也可能是可逆的。
