Department of Anesthesiology, Emergency and Intensive Care, Nemocnice České Budějovice, a.s, České Budějovice, Czechia.
Department of Cardiac Surgery, Heart Centre, Nemocnice České Budějovice, a.s, České Budějovice, Czechia.
J Med Case Rep. 2024 Sep 22;18(1):457. doi: 10.1186/s13256-024-04795-7.
Bacterial pneumonia is one of the most common causes of acute respiratory distress syndrome. In fulminant cases, when mechanical ventilation fails, veno-venous extracorporeal membrane oxygenation is required. However, this method is still associated with significant mortality and a wide range of potential complications. However, there are now many case reports of good outcomes even in patients with prolonged extracorporeal oxygenation, as in our rather complicated case report.
Our case report describes a complicated but successful treatment of a severe, devastating bacterial pneumonia in a 39-year-old European polymorbid woman with a rare form of diabetes mellitus, which had been poorly compensated for a long time with limited compliance, in the context of a combined immunodeficiency that strongly influenced the course of the disease. The patient's hospitalization required a total of 30 days of veno-venous extracorporeal membrane oxygenation therapy and more than 50 days of mechanical ventilation. Numerous complications, particularly bleeding, required seven chest drains, two extracorporeal membrane oxygenation circuit changes, and one surgical revision. The patient's mental state required repeated psychiatric intervention.
It is possible that even the initially severely damaged lung parenchyma can develop its regenerative potential if suitable conditions are provided for this process, including a sufficiently long period of extracorporeal membrane oxygenation. We believe that this case report may also contribute to the consideration of the indications and contraindications of extracorporeal support. The authors also discuss the limitations and risks of prolonged veno-venous extracorporeal membrane oxygenation support and periprocedural anticoagulation strategies.
细菌性肺炎是急性呼吸窘迫综合征最常见的病因之一。在暴发性病例中，当机械通气失败时，需要进行静脉-静脉体外膜氧合。然而，这种方法仍然与显著的死亡率和广泛的潜在并发症相关。然而，现在有许多病例报告表明，即使在需要长时间体外氧合的患者中，也可以取得良好的结果，就像我们的这个相当复杂的病例报告一样。
我们的病例报告描述了一位 39 岁的欧洲多系统疾病女性患者，她患有罕见的糖尿病，长期代偿不良，依从性有限，同时存在联合免疫缺陷，这些因素强烈影响了疾病的进程，导致了严重、破坏性的细菌性肺炎。患者的住院治疗总共需要 30 天的静脉-静脉体外膜氧合治疗和超过 50 天的机械通气。许多并发症，特别是出血，需要七个胸腔引流管、两次体外膜氧合回路更换和一次手术修正。患者的精神状态需要反复进行精神科干预。
如果为这个过程提供合适的条件，包括足够长的体外膜氧合时间，即使最初严重受损的肺实质也有可能发展其再生潜能。我们认为，这个病例报告也可能有助于考虑体外支持的适应证和禁忌证。作者还讨论了延长静脉-静脉体外膜氧合支持的局限性和风险，以及围手术期抗凝策略。
