Department of Critical Care Medicine, Nanjing First Hospital, Nanjing, Jiangsu Province, China.
Department of Critical Care Medicine, Nanjing First Hospital, Nanjing, Jiangsu Province, China.
Heart Lung. 2020 Nov-Dec;49(6):692-695. doi: 10.1016/j.hrtlng.2020.08.009. Epub 2020 Aug 20.
. An outbreak of acute respiratory illness was proved to be infected by a novel coronavirus, officially named Coronavirus Disease 2019 (COVID-19) from World Health Organization (WHO), was confirmed first in Wuhan, China, and has become endemic worldwide, which was a serious threaten to public health all over the world. Herein, we reported a successful critical case of COVID-19 and shared our experience of treatment, which would do a favor for other COVID-19 patients.
. A 65-year-old man, Wuhan citizen, was infected by COVID-19, and his pulmonary lesions progressed quickly in five days. On admission to Tongji Hospital, Wuhan, China, the immediate arterial blood gas(ABG) analysis showed the PaO2/FiO2(P/F) ratio was 134.4mmHg, moderate acute respiratory distress syndrome(ARDS) was diagnosed. Emergency tracheal intubation was performed, and the initial ventilator mode and parameters were set up based on the lung-protective ventilation strategy, but the P/F ratio could not be improved, and then the prone position ventilation was carried out for four consecutive days, as long as 16 hours every day, the P/F ratio rose to 180mmHg approximately, which still did not reach to the standard of extubation. And then we found that it was complicated with acute cor pulmonale(ACP) by ultrasound examination, dobutamine and diuretic were used for the treatment of ACP caused by ARDS successfully, and the P/F ratio went up to about 250mmHg. Seven days later after admission, the endotracheal intubation was successfully removed, after extubation, High-Flow nasal cannula(HFNC) oxygen therapy was used as a sequential strategy to prevent reintubation. Ultimately, he was discharged on day 34 after admission.
. Our case presented the treatment process of a critical COVID-19. Effective therapy was crucial to heal COVID-19, and organ function support therapy, especially the cardiorespiratory function support therapy, was the core of treatment.
一种新型冠状病毒引起的急性呼吸道疾病爆发被世界卫生组织（WHO）正式命名为 2019 年冠状病毒病（COVID-19），最初在中国武汉被证实，现已在全球流行，这对全球公共卫生构成了严重威胁。在此，我们报告了一例 COVID-19 重症成功救治病例，并分享了我们的治疗经验，以期对其他 COVID-19 患者有所帮助。
一名 65 岁的武汉市民感染了 COVID-19，他的肺部病变在五天内迅速进展。患者入住中国武汉同济医院时，即时动脉血气（ABG）分析显示 PaO2/FiO2（P/F）比值为 134.4mmHg，诊断为中度急性呼吸窘迫综合征（ARDS）。立即行气管插管，根据肺保护性通气策略设置初始呼吸机模式和参数，但 P/F 比值无法改善，随后行连续 4 天的俯卧位通气，每天 16 小时，P/F 比值约上升至 180mmHg，但仍未达到拔管标准。然后我们通过超声检查发现合并急性肺源性心脏病（ACP），使用多巴酚丁胺和利尿剂成功治疗 ARDS 引起的 ACP，P/F 比值上升至约 250mmHg。入院后第 7 天，成功拔除气管插管，拔管后采用经鼻高流量湿化氧疗（HFNC）作为序贯策略，以预防再次插管。最终，患者在入院第 34 天出院。
本病例呈现了一例重症 COVID-19 的治疗过程。有效的治疗对于治愈 COVID-19至关重要，器官功能支持治疗，特别是心肺功能支持治疗，是治疗的核心。
