成功应用轻度治疗性低体温作为 COVID-19 严重难治性低氧血症的同情治疗。

Successful use of mild therapeutic hypothermia as compassionate treatment for severe refractory hypoxemia in COVID-19.

机构信息

Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Chile; Centro de Investigación de Medicina Veterinaria, Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Chile; Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Chile..

Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Chile.

出版信息

J Crit Care. 2021 Jun;63:260-263. doi: 10.1016/j.jcrc.2021.01.008. Epub 2021 Jan 23.

DOI:10.1016/j.jcrc.2021.01.008

PMID:33583631

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7825805/

Abstract

BACKGROUND

COVID-19 is a disease associated with an intense systemic inflammation that could induce severe acute respiratory distress syndrome (ARDS), with life-threatening hypoxia and hypercapnia. We present a case where mild therapeutic hypothermia was associated with improved gas exchange, facing other therapies' unavailability due to the pandemic.

CASE REPORT

A healthy 38-year-old male admitted for COVID-19 pneumonia developed extreme hypoxia (PaO/FiO ratio 42 mmHg), respiratory acidosis, and hyperthermia, refractory to usual treatment (mechanical ventilation, neuromuscular blockade, and prone position), and advanced therapies were not available. Mild therapeutic hypothermia management (target 33-34 °C) was maintained for five days, with progressive gas exchange improvement, which allowed his recovery over the following weeks. He was discharged home after 68 days without significant ICU associated morbidity.

CONCLUSIONS

Mild hypothermia is a widely available therapy, that given some specific characteristics of COVID-19, may be explored as adjunctive therapy for life-threatening ARDS, especially during a shortage of other rescue therapies.

摘要

背景

COVID-19 是一种与强烈全身炎症相关的疾病，可能导致严重的急性呼吸窘迫综合征（ARDS），伴有危及生命的低氧血症和高碳酸血症。我们报告了一例轻度治疗性低温与改善气体交换相关的病例，由于大流行，其他治疗方法无法使用。

病例报告

一名健康的 38 岁男性因 COVID-19 肺炎入院，出现极度低氧血症（PaO/FiO 比值为 42mmHg）、呼吸性酸中毒和发热，对常规治疗（机械通气、神经肌肉阻滞和俯卧位）无反应，且无法使用高级治疗方法。轻度治疗性低温管理（目标 33-34°C）持续了五天，气体交换逐渐改善，随后几周逐渐恢复。他在 68 天后出院回家，没有明显的 ICU 相关发病率。