Huette Pierre, Abou Arab Osama, Jounieaux Vincent, Guilbart Mathieu, Belhout Mohamed, Haye Guillaume, Dupont Hervé, Beyls Christophe, Mahjoub Yazine
Department of Anaesthesia and Critical Care, Amiens Hospital University, Amiens 80000, France.
Department of Respiratory Medicine, Amiens Hospital University, Amiens 80000, France.
World J Clin Cases. 2021 May 16;9(14):3385-3393. doi: 10.12998/wjcc.v9.i14.3385.
Several reports with clinical, histological and imaging data have observed the involvement of lung vascular function to explain the severe hypoxemia in coronavirus disease 2019 (COVID-19) patients. It has been hypothesized that an increased pulmonary blood flow associated with an impairment of hypoxic pulmonary vasoconstriction is responsible for an intrapulmonary shunt. COVID-19 may lead to refractory hypoxemia (PaO/FiO ratio below 100 mmHg) despite mechanical ventilation and prone positioning. We hypothesized that the use of a pulmonary vasoconstrictor may help decrease the shunt and thus enhance oxygenation.
We report our experience with three patients with refractory hypoxemia treated with almitrine to enhance oxygenation. Low dose almitrine (Vectarion; Servier, Suresnes, France) was started at an infusion rate of 4 μg × kg/min on a central line. The PaO/FiO ratio and total respiratory system compliance during almitrine infusion were measured. For the three patients, the PaO/FiO ratio time-course showed a dramatic increase whereas total respiratory system compliance was unchanged. The three patients were discharged from the intensive care unit. The intensive care unit length of stay for patient 1, patient 2 and patient 3 was 30 d, 32 d and 31 d, respectively. Weaning from mechanical ventilation was performed 13 d, 18 d and 15 d after almitrine infusion for patient 1, 2 and 3, respectively. We found no deleterious effects on the right ventricular function, which was similar to previous studies on almitrine safety.
Almitrine may be effective and safe to enhance oxygenation in coronavirus disease 2019 patients. Further controlled studies are required.
多项包含临床、组织学和影像学数据的报告观察到肺血管功能的参与，以解释2019冠状病毒病（COVID-19）患者的严重低氧血症。据推测，与低氧性肺血管收缩受损相关的肺血流量增加是肺内分流的原因。尽管进行了机械通气和俯卧位通气，COVID-19仍可能导致难治性低氧血症（动脉血氧分压/吸入氧分数值低于100 mmHg）。我们推测使用肺血管收缩剂可能有助于减少分流，从而改善氧合。
我们报告了3例使用烯丙哌三嗪改善氧合治疗难治性低氧血症患者的经验。低剂量烯丙哌三嗪（Vectarion；法国施维雅公司，叙雷讷）通过中心静脉以4 μg×kg/min的输注速率开始给药。在输注烯丙哌三嗪期间测量动脉血氧分压/吸入氧分数值和全呼吸系统顺应性。对于这3例患者，动脉血氧分压/吸入氧分数值的时间进程显示显著增加，而全呼吸系统顺应性未改变。这3例患者均从重症监护病房出院。患者1、患者2和患者3在重症监护病房的住院时间分别为30天、32天和31天。分别在烯丙哌三嗪输注后13天、18天和15天对患者1、2和3进行机械通气撤机。我们未发现对右心室功能有不良影响，这与先前关于烯丙哌三嗪安全性的研究相似。
烯丙哌三嗪在改善2019冠状病毒病患者氧合方面可能有效且安全。需要进一步的对照研究。
