Dieterich Frank, Perras Jan, Popp Wolfram, Ahrens Marlena, Wirth Steffen
Abteilung fur Anästhesie, Intensiv- und Schmerzmedizin, BG Unfallklinik Murnau, Prof.-Kuntscher-Str. 8, D - 82418 Murnau, Deutschland.
Procare. 2023;28(1-2):12-16. doi: 10.1007/s00735-023-1654-8. Epub 2023 Feb 4.
An effective (early) mobilization in COVID-19 intensive care patients with ECMO treatment is very important. Sedation, extracorporeal procedures with the danger of circuit malfunction, large lumen ECMO cannulas with a risk of dislocation and a very severe neuromuscular weakness are factors that could deem mobilization beyond stage 1 of the ICU mobility score (IMS) in some cases difficult or impossible; however, early mobilization is a key point of the ABCDEF bundle to counteract pulmonary complications, neuromuscular dysfunction and enable recovery. The case of a 53-year-old, previously healthy and active male patient with a severe and complicated course of COVID-19 and pronounced ICU-acquired weakness is described. While receiving ECMO the patient could be mobilized using a robotic system. Due to severe and rapidly progressing pulmonary fibrosis, additional low-dose methylprednisolone therapy (Meduri protocol) was implemented. Under this multimodal treatment the patient was successfully weaned from the ventilator and decannulated. Robotic assisted mobilization has the potential to be a novel and safe therapeutic option for a customized and highly effective mobilization in ECMO patients.
对接受体外膜肺氧合（ECMO）治疗的新冠肺炎重症监护患者进行有效的（早期）活动非常重要。镇静、存在回路故障风险的体外操作、有移位风险的大口径ECMO插管以及非常严重的神经肌肉无力等因素，在某些情况下可能会使患者难以或无法达到重症监护病房活动评分（IMS）的第1阶段以上；然而，早期活动是ABCDEF集束化治疗的关键要点，有助于对抗肺部并发症、神经肌肉功能障碍并促进康复。本文描述了一名53岁、既往健康且活跃的男性患者，其新冠肺炎病情严重且复杂，伴有明显的重症监护病房获得性肌无力。在接受ECMO治疗期间，该患者可使用机器人系统进行活动。由于严重且迅速进展的肺纤维化，实施了额外的低剂量甲泼尼龙治疗（梅杜里方案）。在这种多模式治疗下，患者成功脱机并拔除插管。机器人辅助活动有可能成为一种新颖且安全的治疗选择，用于为接受ECMO治疗的患者进行定制化且高效的活动。
