Achanta Nikhil, Vujcikova Julia, Nichani Sahil, Nichani Sanjiv
Paediatric Intensive Care Unit, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
Paediatric Intensive Care Unit, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
BMJ Case Rep. 2020 Nov 2;13(11):e237012. doi: 10.1136/bcr-2020-237012.
We are reporting two paediatric cases with severe adenoviral acute respiratory distress syndrome with viral counts of 308 and 119 million copies/mL respectively, who required venoarterial extracorporeal membrane oxygenation (ECMO) support for nearly 3 weeks. They were static on ECMO and had shown a complete lack of response to all therapeutic interventions aimed at decreasing ECMO support. To facilitate weaning from ECMO, they received 2-3 doses of surfactant. This led to dramatic improvement in pulmonary compliance, oxygenation and chest X-ray. They were both weaned off ECMO within 24 hours of receiving surfactant. Surfactant was well tolerated, with no adverse effects. In both cases, weaning from ECMO was possible only after surfactant administration. From our experience, we conclude that surfactant administration is a potentially safe and effective treatment modality that helps weaning from ECMO and should be considered in patients who are dependent on ECMO for long duration.
我们报告了两例患有严重腺病毒急性呼吸窘迫综合征的儿科病例，病毒载量分别为3.08亿拷贝/毫升和1.19亿拷贝/毫升，他们需要静脉-动脉体外膜肺氧合（ECMO）支持近3周。他们在ECMO上情况稳定，并且对所有旨在减少ECMO支持的治疗干预均完全没有反应。为了促进从ECMO撤机，他们接受了2 - 3剂表面活性剂。这导致肺顺应性、氧合和胸部X线显著改善。他们在接受表面活性剂后的24小时内均成功撤离了ECMO。表面活性剂耐受性良好，没有不良反应。在这两个病例中，只有在给予表面活性剂后才有可能从ECMO撤机。根据我们的经验，我们得出结论，给予表面活性剂是一种潜在安全有效的治疗方式，有助于从ECMO撤机，对于长期依赖ECMO的患者应予以考虑。
