Kohara Jumpei, Kai Shinichi, Hashimoto Kazuya, Takatani Yudai, Tanabe Naoya, Hamada Satoshi, Cho Kosai, Tanaka Tomoharu, Ito Isao, Ohtsuru Shigeru
Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan.
Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
JA Clin Rep. 2022 Feb 21;8(1):12. doi: 10.1186/s40981-022-00505-8.
Ventilatory management of respiratory failure with pneumomediastinum/subcutaneous emphysema is not established. Herein, we report a case of severe COVID-19 pneumonia with extensive pneumomediastinum/subcutaneous emphysema, rescued by thorough lung-protective ventilatory management after applying the VV-ECMO.
A 68-year-old male with no medical history was admitted to a local hospital and diagnosed with COVID-19 pneumonia. His pulmonary parameters worsened during invasive ventilation due to the development of pneumomediastinum/subcutaneous emphysema, and then he was transferred to our hospital. On arrival, we immediately decided to apply VV-ECMO and switch to ultraprotective ventilation. After maintaining the initial ventilation with a neuromuscular blocking agent for 2 days, we gradually increased PEEP while limiting PIP to 25 cmHO. The patient was weaned off VV-ECMO on day 10; he was transferred to the medical ward after extubation.
Lung-protective ventilatory management should be performed thoroughly during VV-ECMO in severe COVID-19 pneumonia with pneumomediastinum/subcutaneous emphysema.
伴有纵隔气肿/皮下气肿的呼吸衰竭的通气管理尚未确立。在此，我们报告一例严重新型冠状病毒肺炎合并广泛纵隔气肿/皮下气肿的病例，在应用体外膜肺氧合（VV-ECMO）后，通过全面的肺保护性通气管理得以救治。
一名无病史的68岁男性因新型冠状病毒肺炎入住当地医院。由于发生纵隔气肿/皮下气肿，其在有创通气期间肺部参数恶化，随后转至我院。入院后，我们立即决定应用VV-ECMO并转为超保护性通气。在使用神经肌肉阻滞剂维持初始通气2天后，我们逐渐增加呼气末正压（PEEP），同时将气道峰压（PIP）限制在25 cmH₂O。患者在第10天撤离VV-ECMO；拔管后转至内科病房。
对于合并纵隔气肿/皮下气肿的严重新型冠状病毒肺炎患者，在VV-ECMO治疗期间应全面实施肺保护性通气管理。
