Wang Lu, Shi Zhaokun, Chen Wei, Du Xianjin, Zhan Liying
Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China.
Front Med (Lausanne). 2021 Oct 15;8:731047. doi: 10.3389/fmed.2021.731047. eCollection 2021.
Infection of () could lead to serious clinical manifestations in humans, including severe pneumonia with rapid progression, adult respiratory distress syndrome (ARDS), sepsis, multiple organ dysfunction syndromes (MODS), and probably death. Implementation of extracorporeal membrane oxygenation (ECMO) in the patient with severe ARDS gives a promising new method for recovery. We report our successful use of venovenous (VV) ECMO in a 48-year-old man who manifested with severe respiratory distress syndrome, acute kidney injury, and septic shock caused by a diagnosis of pneumonia. After the combination of therapy including anti-infection, mechanical ventilation, and continuous renal replacement therapy (CRRT), acute inflammatory syndrome developed. However, his respiratory status rapidly deteriorated. Then, venoarterial (VA)-ECMO support was placed on the patient as suddenly slowing of the heart rate. Harlequin (North-South) syndrome occurred after ECMO initiation. A series of the process could not relieve hypoxia in the upper body. At last, transition to VV-ECMO improved hypoxia. The duration of VV-ECMO was 7 days and the mechanical ventilation was weaned on the next day. On the day of ECMO weaning, nanopore targeted sequencing (NTS) of bronchoalveolar lavage fluid (BALF) reported the presence of . After 19 days of critical systemic rehabilitation and combination therapy, the patient fully recovered from . This is the first reported case of the patient receiving ECMO for pneumonia. ECMO puts the lungs on temporary rest, promotes the recovery of pulmonary function, and also wins time for finding the pathogens, which is crucial in the treatment of rare pathogens.
()感染可导致人类出现严重的临床表现,包括进展迅速的重症肺炎、成人呼吸窘迫综合征(ARDS)、脓毒症、多器官功能障碍综合征(MODS),甚至可能导致死亡。对重症ARDS患者实施体外膜肺氧合(ECMO)为康复提供了一种有前景的新方法。我们报告了成功应用静脉-静脉(VV)ECMO治疗一名48岁男性患者的病例,该患者表现为严重呼吸窘迫综合征、急性肾损伤及因肺炎诊断导致的感染性休克。在联合抗感染、机械通气及持续肾脏替代治疗(CRRT)等治疗后,出现了急性炎症综合征。然而,其呼吸状况迅速恶化。随后,因心率突然减慢对患者实施了静脉-动脉(VA)-ECMO支持。ECMO启动后发生了丑角(南北)综合征。一系列措施均未能缓解上身缺氧情况。最后,转为VV-ECMO改善了缺氧状况。VV-ECMO持续时间为7天,次日撤机。在ECMO撤机当天,支气管肺泡灌洗液(BALF)的纳米孔靶向测序(NTS)报告发现了(此处原文缺失相关病原体名称)。经过19天的重症全身康复及联合治疗,患者从(此处原文缺失相关疾病名称)中完全康复。这是首例报道的因(此处原文缺失相关病原体名称)肺炎接受ECMO治疗的患者病例。ECMO使肺得到暂时休息,促进肺功能恢复,也为寻找病原体赢得时间,这在罕见病原体治疗中至关重要。
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