Nakanishi Nobuto, Okamoto Yuri, Okahisa Tetsuya, Oto Jun
Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, JPN.
Respiratory Medicine and Rheumatology, Tokushima University Hospital, Tokushima, JPN.
Cureus. 2020 Aug 21;12(8):e9926. doi: 10.7759/cureus.9926.
Patients with acute respiratory distress syndrome (ARDS) exhibit prominent muscle atrophy and weakness. Although these patients often require deep sedation to perform lung-protective ventilation, extracorporeal membrane oxygenation (ECMO) can keep patients awake and make mobilization possible. A 60-year-old man was treated with ECMO due to ARDS. A multidisciplinary team conducted mobilization with standing on day 3. During intensive care unit (ICU) stay, catabolism was ongoing (urinary titin: 24.1-38.4 pmol/mg Cr), but the rectus femoris muscle, measured by ultrasound, moderately decreased by 5.3%, 10.8%, and 13.0% on days 3, 5, and 7, respectively, with maintained Medical Research Council score of 58-60. Diaphragm thickness remained unchanged. On day 5, he was separated from ECMO. After ambulation training, he was discharged from ICU on day 7. He returned home without prominent physical dysfunction. Our experience indicates early initiation of awake ECMO can accompany mobilization and attenuate muscle atrophy and weakness in ARDS.
急性呼吸窘迫综合征（ARDS）患者表现出明显的肌肉萎缩和无力。尽管这些患者通常需要深度镇静以进行肺保护性通气，但体外膜肺氧合（ECMO）可使患者保持清醒并实现活动。一名60岁男性因ARDS接受ECMO治疗。一个多学科团队在第3天进行了站立活动。在重症监护病房（ICU）住院期间，分解代谢持续存在（尿肌联蛋白：24.1 - 38.4 pmol/mg Cr），但通过超声测量，股直肌在第3天、第5天和第7天分别适度减少了5.3%、10.8%和13.0%，医学研究委员会评分维持在58 - 60分。膈肌厚度保持不变。在第5天，他脱离了ECMO。经过步行训练，他在第7天从ICU出院。他回家时没有明显的身体功能障碍。我们的经验表明，早期启动清醒ECMO可伴随活动，并减轻ARDS患者的肌肉萎缩和无力。
