Peters Rachael A, Cancio Jill M, Glenn Keith, Cancio Leopoldo C
School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
U.S. Army Institute of Surgical Research, Fort Sam Houston, San Antonio, TX 78234, USA.
J Burn Care Res. 2024 May 6;45(3):796-800. doi: 10.1093/jbcr/irae027.
Inhalation injury is a major risk factor for mortality in burn patients via 3 primary mechanisms: airway edema and obstruction, hypoxemic respiratory failure, and pneumonia. Currently, the mainstay of treatment is supportive care to include early intubation, lung-protective or high-frequency-percussive mechanical ventilation, nebulized heparin, and aggressive pulmonary toilet. Despite these treatments, a subset of these patients progress to severe acute respiratory distress syndrome (ARDS) for which rescue options are limited.
A 31-year-old woman was found down in a house fire. On admission to the burn intensive care unit, she was diagnosed with grade 3 smoke inhalation injury. Cutaneous thermal injury was absent. By hospital day 2, she developed worsening hypoxemia and hypercapnia despite maximal ventilatory support. She was placed on veno-venous extracorporeal membrane oxygenation (ECMO). She received an average of 2.2 hours of direct rehabilitation a day and completed out-of-bed modalities over 90% of total hospital days. After 159 hours, she was decannulated, and by hospital day 18, she was discharged home on supplemental oxygen.
Current literature regarding ECMO in inhalation injury is limited, but a growing body of evidence suggests that treatment of severe smoke inhalation injury should include ECMO for those who fail conventional therapy.
吸入性损伤是烧伤患者死亡的主要危险因素，主要通过三种主要机制导致死亡：气道水肿与梗阻、低氧性呼吸衰竭和肺炎。目前，治疗的主要方法是支持性治疗，包括早期插管、肺保护性或高频震荡机械通气、雾化肝素以及积极的肺部护理。尽管采取了这些治疗措施，但仍有一部分患者会进展为严重急性呼吸窘迫综合征（ARDS），而针对这种情况的挽救治疗选择有限。
一名31岁女性在房屋火灾中被发现。入院时入住烧伤重症监护病房，被诊断为3级烟雾吸入性损伤，无皮肤热损伤。到住院第2天，尽管给予了最大程度的通气支持，她的低氧血症和高碳酸血症仍不断加重。她接受了静脉 - 静脉体外膜肺氧合（ECMO）治疗。她平均每天接受2.2小时的直接康复治疗，并且在超过90%的住院天数中完成了离床活动。159小时后，她拔除了ECMO导管，到住院第18天，她在家中依靠吸氧出院。
目前关于吸入性损伤中ECMO治疗的文献有限，但越来越多的证据表明，对于常规治疗失败的严重烟雾吸入性损伤患者，治疗应包括ECMO。
