Wu Xiaoyan, Zheng Ruiqiang, Zhao Zhanqi
Medical College of Yangzhou University, Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou, China.
School of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China.
Front Med (Lausanne). 2024 May 3;11:1371183. doi: 10.3389/fmed.2024.1371183. eCollection 2024.
Interstitial pneumonia is the most common and serious secondary lesion of dermatomyositis. In some cases, patients may develop severe acute pneumonia that can quickly progress to respiratory failure, resulting in high mortality rates. A 57-year-old woman with dermatomyositis and interstitial pulmonary fibrosis experienced severe hypoxemia due to pulmonary infection. Despite receiving various treatments after entering the intensive care unit (ICU), such as anti-infection therapy, lung recruitment, prone position ventilation, sedative and muscle relaxation, the patient's oxygen saturation continued to decline. Electrical impedance tomography (EIT) monitoring revealed that prone position could not improve ventilation homogeneity. However, the patient's ventilation/perfusion (V/Q) matching significantly improved 10 min after initiation of supine position ventilation combined with inhalation of nitric oxide (iNO). The patient's PaO/FiO (P/F) ratio increased from 86 mmHg to 150 mmHg at 30 min post-treatment. iNO treatment continued for 2 days. Then the patient's condition improved and she was successfully weaned off the ventilator with rigorous monitoring and symptomatic care. The implementation of mechanical ventilation combined with iNO therapy rapidly improved V/Q matching and oxygenation in a patient with hypoxemia caused by dermatomyositis complicated with interstitial pneumonia. This approach successfully avoided the need for invasive extracorporeal membrane oxygenation (ECMO) support.
间质性肺炎是皮肌炎最常见且最严重的继发性病变。在某些情况下，患者可能会发展为严重的急性肺炎，并迅速进展为呼吸衰竭，导致高死亡率。一名患有皮肌炎和间质性肺纤维化的57岁女性因肺部感染出现严重低氧血症。进入重症监护病房（ICU）后，尽管接受了各种治疗，如抗感染治疗、肺复张、俯卧位通气、镇静和肌肉松弛，但患者的血氧饱和度仍持续下降。电阻抗断层扫描（EIT）监测显示，俯卧位并不能改善通气均匀性。然而，在开始仰卧位通气并吸入一氧化氮（iNO）后10分钟，患者的通气/灌注（V/Q）匹配情况显著改善。治疗后30分钟，患者的动脉血氧分压/吸入氧分数值（PaO/FiO，P/F）比值从86 mmHg升至150 mmHg。iNO治疗持续了2天。随后患者病情好转，经过严密监测和对症护理，成功脱机。对于皮肌炎合并间质性肺炎所致低氧血症患者，实施机械通气联合iNO治疗可迅速改善V/Q匹配和氧合情况。这种方法成功避免了有创体外膜肺氧合（ECMO）支持的需要。
