Nakajima H, Kutsuwada T, Ohdaira T, Saito A, Satoh K, Igarashi K, Suzuki E, Arakawa M
Department of Medicine (II), Niigata University School of Medicine, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Dec;35(12):1363-7.
We report a case of severe legionella pneumonia with acute respiratory failure, successfully managed with veno-venous extracorporeal membrane oxygenation (VV-ECMO). The patient presented with 4-day history of fever and cough. He was in critical condition, with exacerbated respiratory failure. Mechanical ventilation, volume replacement and antibiotic therapy were initiated. Despite increasing mechanical ventilatory support (FiO2 100%, TV 10 ml/kg, f 30/min, PEEP 5 cmH20), PaO2 fell below 40Torr and life sustaining measures were undertaken. VV-ECMO (flow 30 ml/kg/min) was commenced, and the patient responded well, with an elevation of PaO2. Erythromycin therapy was effective against the pneumonia. VV-ECMO was maintained for 92 hours, mechanical ventilation was successfully discontinued 11 days after and the patient was discharged 82 days after cessation of ventilator support. Serum antibody examination proved legionella infection. VV-ECMO may have a role in the management of patients with acute respiratory failure caused by bacterial pneumonia.
我们报告一例伴有急性呼吸衰竭的重症军团菌肺炎病例，通过静脉-静脉体外膜肺氧合（VV-ECMO）成功救治。患者有4天的发热和咳嗽病史。他病情危急，呼吸衰竭加重。开始进行机械通气、补液和抗生素治疗。尽管增加了机械通气支持（FiO2 100%，潮气量10 ml/kg，频率30次/分钟，呼气末正压5 cmH20），但动脉血氧分压（PaO2）仍降至40 Torr以下，于是采取了维持生命的措施。开始使用VV-ECMO（流量30 ml/kg/分钟），患者反应良好，PaO2有所升高。红霉素治疗对肺炎有效。VV-ECMO维持了92小时，11天后成功停用机械通气，停止通气支持82天后患者出院。血清抗体检查证实为军团菌感染。VV-ECMO可能在治疗由细菌性肺炎引起的急性呼吸衰竭患者中发挥作用。
