Patton M L, Simone M R, Kraut J D, Anderson H L, Haith L R
The Nathan Speare Regional Burn Treatment Center, Department of Surgery Crozer-Chester Medical Center, Upland, PA, USA.
Burns. 1998 Sep;24(6):566-8. doi: 10.1016/s0305-4179(98)00067-9.
We present an interesting case of the first adult reported in the United States to suffer from thermal burns, adult respiratory distress syndrome (ARDS) and to be treated with extracorporeal membrane oxygenation (ECMO) who survived. Our patient is a 26 year old male who sustained thermal burns (12% TBSA) to his face and anterior trunk and broncoscopically demonstrable inhalation injury. He was transported to our regional burn center for burn wound care and ventilatory support. The patient was treated with silver sulfadiazine 1% to his wounds which healed per primam. Because of low oxygen saturation he required increasing FIO2. The following parameters: FIO2= 1, PEEP = 17, minute ventilation of 15.1 1, peak airway pressure of 45 and mean of 27, along with chest X-rays corroborated the severity of ARDS. The patient failed volume control ventilation. A trial of pressure ventilation was attempted but the patient only reached O2 saturation in the low 80s. At this point, the decision was made to transfer the patient to a hospital capable of ECMO treatment. The patient was subsequently treated with veno venous ECMO. Six weeks later the patient was discharged from the hospital off all ventilatory support.
我们报告了美国首例成年热烧伤患者，该患者同时患有成人呼吸窘迫综合征（ARDS），接受体外膜肺氧合（ECMO）治疗后存活。我们的患者是一名26岁男性，面部和前躯干遭受热烧伤（体表面积的12%），经支气管镜检查证实有吸入性损伤。他被转运至我们地区的烧伤中心接受烧伤创面护理和通气支持。患者伤口使用1%磺胺嘧啶银治疗，伤口一期愈合。由于氧饱和度低，他需要增加吸入氧浓度（FIO2）。以下参数：FIO2 = 1、呼气末正压（PEEP） = 17、分钟通气量15.1升、气道峰压45及平均压27，以及胸部X光片均证实了ARDS的严重程度。患者容量控制通气失败。尝试进行压力通气试验，但患者的氧饱和度仅达到80%多的低值。此时，决定将患者转至能够进行ECMO治疗的医院。患者随后接受了静脉-静脉ECMO治疗。六周后，患者在脱离所有通气支持的情况下出院。
