Wang Li, Wang Jiang, Xu Yi, Jiao Jie, Xie Lixin, Mo Guoxin
Department of Critical Care Medicine, The First Medical Center of PLA General Hospital, Haidian District, Beijing, China.
Department of Pulmonary & Critical Care Medicine, The Eighth Medical Center of PLA General Hospital, Haidian District, Beijing, China.
Ann Transl Med. 2021 Aug;9(15):1267. doi: 10.21037/atm-21-3133.
Diffuse alveolar hemorrhage (DAH) secondary to anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) often results in severe respiratory failure which requires emergent management. In patients who are resistant to traditional mechanical respiratory support, extracorporeal membrane oxygenation (ECMO) can be used to maintain gas exchange, thereby providing time for the administration of immunosuppressive therapy to control the inflammation. Herein, we report the application of ECMO to support an adult patient with AAV complicated by severe respiratory failure due to DAH. Similar cases in the literature were identified and discussed. The patient in our case study was successfully treated with ECMO in the acute phase and relieved by immunosuppressive therapy after withdrawal of ECMO. A search in the PubMed database revealed 32 similar cases with DAH, of which 11 cases were microscopic polyangiitis (MPA), 2 cases were eosinophilic granulomatosis with polyangiitis (EGPA), and 19 cases were granulomatosis with polyangiitis (GPA). These patients were all treated with ECMO. Therefore, to date, we identified 33 patients who were effectively treated with ECMO, including 13 (39.4%) males and 20 (60.6%) females, with a ratio of 1:1.54. The average age was 32.4±17.5 and 36.0±16.1 years for males and females, respectively (t=0.610, P=0.547). Most patients received ECMO on the first day of admission to the intensive care unit (ICU) and it appeared that early initiation of ECMO was associated with a shorter duration of ECMO. In general, complications of ECMO in these patients were mild and were not often seen in the clinical setting. This study suggested that early recognition of respiratory failure and referral for ECMO are vital to achieve a satisfactory outcome in AAV patients with DAH.
抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）继发的弥漫性肺泡出血（DAH）常导致严重呼吸衰竭，需要紧急处理。对于传统机械通气支持无效的患者，可使用体外膜肺氧合（ECMO）维持气体交换，从而为给予免疫抑制治疗控制炎症争取时间。在此，我们报告ECMO在一名因DAH并发严重呼吸衰竭的AAV成年患者中的应用。同时对文献中的类似病例进行了检索和讨论。我们病例研究中的患者在急性期通过ECMO成功治疗，撤机后经免疫抑制治疗缓解。在PubMed数据库中检索到32例类似的DAH病例，其中11例为显微镜下多血管炎（MPA），2例为嗜酸性肉芽肿性多血管炎（EGPA），19例为肉芽肿性多血管炎（GPA）。这些患者均接受了ECMO治疗。因此，截至目前，我们共确定了33例接受ECMO有效治疗的患者，其中男性13例（39.4%），女性20例（60.6%），男女比例为1:1.54。男性和女性的平均年龄分别为32.4±17.5岁和36.0±16.1岁（t = 0.610，P = 0.547）。大多数患者在入住重症监护病房（ICU）的第一天就接受了ECMO治疗，似乎早期启动ECMO与缩短ECMO使用时间相关。总体而言，这些患者中ECMO的并发症较轻，在临床中并不常见。本研究表明，早期识别呼吸衰竭并转诊接受ECMO治疗对于AAV合并DAH患者取得满意疗效至关重要。
