Biblowitz Kathleen, Mullin Megan, McDermott Lydia, Sykuta Alyssa, Baram Michael, Hirose Hitoshi
Division of Critical Care, Thomas Jefferson University, Philadelphia, PA, USA.
AME Case Rep. 2022 Jan 25;6:8. doi: 10.21037/acr-21-51. eCollection 2022.
Patients with novel coronavirus 2019 (COVID-19) may develop acute respiratory distress syndrome (ARDS) and require extracorporeal membrane oxygenation (ECMO) support. Currently there is no specific treatment for COVID-19 available; thus, for patients with severe ARDS, the respiratory condition needs to improve while on ECMO support. Here we present a multidisciplinary team approach to the care of a patient with COVID-related ARDS requiring three months of veno-venous (VV) ECMO which lead to recovery. A 35-year-old male was transferred to us with ARDS due to COVID-19 infection with a lactate 13.7 mmol/L and an arterial-blood gas oxygenation of 75 mmHg on maximum ventilator settings. He was placed on VV ECMO during which he developed pneumonia, bacteremia, and pneumothoraces; however, his other organ functions were preserved. During his time in the Intensive Care Unit (ICU), multiple subspecialist teams participated in his care including physicians, pharmacists, nurses, nutritionists, case management, and social work. The VV ECMO was weaned off after 91 days of support, after which he had a prolonged hospital course due to inflammatory bowel disease, and aspiration pneumonia. CT scan performed six weeks prior to discharge showed mild improvement in diffuse airspace opacities superimposed on extensive chronic cystic changes. He was eventually discharged to a rehabilitation facility 68 days after ECMO removal. He was then seen in our outpatient pulmonary clinic one month and our Post-Intensive Care Syndrome clinic three months after discharge on two liters of nasal cannula oxygen. Pulmonary function testing done at this time demonstrated severe restrictive lung disease and severely reduced diffusion capacity. This case highlights the need for multidisciplinary collaboration among hospital teams to ensure success and patient survival in the setting of COVID ARDS. In those COVID ARDS patients with intact renal, metabolic, hematologic, and cardiovascular function, ECMO should be strongly considered.
2019新型冠状病毒病（COVID-19）患者可能会发展为急性呼吸窘迫综合征（ARDS）并需要体外膜肺氧合（ECMO）支持。目前尚无针对COVID-19的特效治疗方法；因此，对于重症ARDS患者，在接受ECMO支持期间需要改善呼吸状况。在此，我们介绍一种多学科团队方法来护理一名因COVID相关ARDS而需要三个月静脉-静脉（VV）ECMO支持并最终康复的患者。一名35岁男性因COVID-19感染导致ARDS被转至我院，在最大呼吸机设置下乳酸水平为13.7 mmol/L，动脉血气氧合为75 mmHg。他接受了VV ECMO治疗，在此期间出现了肺炎、菌血症和气胸；然而，他的其他器官功能得以保留。在他入住重症监护病房（ICU）期间，多个专科团队参与了他的护理，包括医生、药剂师、护士、营养师、病例管理和社会工作者。在接受91天的支持后，VV ECMO撤机，此后他因炎症性肠病和吸入性肺炎经历了较长的住院过程。出院前六周进行的CT扫描显示，弥漫性气腔混浊在广泛的慢性囊性改变基础上有轻度改善。在ECMO撤除68天后，他最终出院至康复机构。出院后一个月，他在我院门诊肺部诊所就诊，出院三个月后在我院重症后综合征诊所就诊，当时通过鼻导管吸氧两升。此时进行的肺功能测试显示为严重的限制性肺病，弥散能力严重降低。该病例强调了医院团队之间多学科协作对于确保COVID ARDS患者成功救治和存活的必要性。对于那些肾脏、代谢、血液和心血管功能完好的COVID ARDS患者，应强烈考虑使用ECMO。
