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病例报告:一名新冠肺炎重症患者接受47天体外膜肺氧合支持的呼吸管理

Case Report: Respiratory Management With a 47-Day ECMO Support for a Critical Patient With COVID-19.

作者信息

Xu Wen, Tan Ruoming, Huang Jie, Qin Shuai, Wu Jing, Qiu Yuzhen, Xie Simin, Xu Yan, Du Ying, Li Feng, Li Bailing, Li Yingchuan, Gao Yuan, Li Xin, Qu Hongping

机构信息

Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

出版信息

Front Med (Lausanne). 2021 Dec 24;8:714387. doi: 10.3389/fmed.2021.714387. eCollection 2021.

Abstract

This paper reports a complete case of severe acute respiratory distress syndrome (ARDS) caused by coronavirus disease 2019 (COVID-19), who presented with rapid deterioration of oxygenation during hospitalization despite escalating high-flow nasal cannulation to invasive mechanical ventilation. After inefficacy with lung-protective ventilation, positive end-expiratory pressure (PEEP) titration, prone position, we administered extracorporeal membrane oxygenation (ECMO) as a salvage respiratory support with ultra-protective ventilation for 47 days and finally discharged the patient home with a good quality of life with a Barthel Index Score of 100 after 76 days of hospitalization. The purpose of this paper is to provide a clinical reference for the management of ECMO and respiratory strategy of critical patients with COVID-19-related ARDS.

摘要

本文报告了1例由2019冠状病毒病(COVID-19)引起的严重急性呼吸窘迫综合征(ARDS)的完整病例,该患者在住院期间尽管高流量鼻导管吸氧逐步升级至有创机械通气,但氧合仍迅速恶化。在肺保护性通气、呼气末正压(PEEP)滴定、俯卧位治疗无效后,我们给予体外膜肺氧合(ECMO)作为挽救性呼吸支持,并采用超保护性通气47天,患者住院76天后最终出院,生活质量良好,Barthel指数评分达100分。本文旨在为COVID-19相关ARDS危重症患者的ECMO管理和呼吸策略提供临床参考。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6f5b/8739513/17f5274bf0c3/fmed-08-714387-g0001.jpg

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