Miyagawa Ryo, Hamaguchi Jun, Aibara Keiji, Kamochi Masayuki, Shimizu Keiki
Department of Emergency and Intensive Care Medicine, University of Occupational and Environmental Health, Kitakyushu, JPN.
Department of Emergency and Critical Care Medicine, Extracorporeal Membrane Oxygenation (ECMO) Center, Tokyo Metropolitan Tama Medical Center, Tokyo, JPN.
Cureus. 2025 Feb 27;17(2):e79757. doi: 10.7759/cureus.79757. eCollection 2025 Feb.
A 76-year-old man arrived at our hospital post-intubation for coronavirus disease, and veno-venous extracorporeal membrane oxygenation (V-V ECMO) was performed for hypoxemia the same day. Although renal replacement therapy was introduced for anuria due to bacterial pneumonia, the patient became fluid-overloaded. In addition to the effects of fluid overload and pneumonia, the ventilator was adjusted to a lung rest strategy, making oxygen delivery and carbon dioxide (CO) removal almost entirely dependent on ECMO. Even with high-flow sweep gas, CO removal was difficult because of the relatively large body surface area, hypercapnia renal compensation difficulties due to acute kidney injury, increased CO production because of infection, and increased membrane lung shunting secondary to blood coagulation disorders. Therefore, we used double-parallel oxygenators for the hypercapnia and reduced the sweep-gas flow because of the increased membrane lung area. These results suggest that double-parallel oxygenator use provides effective management for refractory hypercapnia during ECMO.
一名76岁男性因冠状病毒病插管后送至我院，同日因低氧血症接受了静脉-静脉体外膜肺氧合（V-V ECMO）治疗。尽管因细菌性肺炎无尿而采用了肾脏替代治疗，但患者出现了液体超负荷。除了液体超负荷和肺炎的影响外，呼吸机调整为肺休息策略，使氧气输送和二氧化碳（CO）清除几乎完全依赖于ECMO。即使使用高流量冲洗气，由于体表面积相对较大、急性肾损伤导致高碳酸血症肾代偿困难、感染导致CO产生增加以及凝血障碍继发膜肺分流增加，CO清除仍很困难。因此，我们使用双平行氧合器治疗高碳酸血症，并因膜肺面积增加而降低了冲洗气流量。这些结果表明，使用双平行氧合器可为ECMO期间难治性高碳酸血症提供有效的管理。
