Extracorporeal Membrane Oxygenation for Refractory Severe Respiratory Failure in Acute Interstitial Pneumonia
Extracorporeal Membrane Oxygenation for Refractory Severe Respiratory Failure in Acute Interstitial Pneumonia
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DOI：
10.1111/aor.13075
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发表时间：
2018-05-01
影响因子：
2.4
通讯作者：
Paiva, Jose Artur
中科院分区：
文献类型：
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作者：
Goncalves-Venade, Gabriela;Lacerda-Principe, Nuno;Paiva, Jose Artur
急性间质性肺炎（AIP）是一种罕见的特发性间质性肺疾病，伴有快速进行性呼吸衰竭和高死亡率。本文报告了3例AIP合并难治性呼吸衰竭并经体外膜氧合（ECMO）治疗的病例。包括1男2女患者（年龄27-59岁）。静脉-静脉ECMO支持采用小型化系统，采用双点股颈电路配置。尽管有肺保护性通气、俯卧位和神经肌肉阻滞，但仍出现不明原因的难固性呼吸衰竭（动脉氧分压与分次吸入氧的比为46-130），并在机械通气3-7天后开始ECMO。根据临床和分析资料、支气管肺泡灌洗分析和肺部影像学检查，排除感染性和非感染性急性呼吸窘迫综合征后，确定AIP诊断，手术肺活检显示病因不明的弥漫性肺泡损伤。免疫抑制治疗包括1例高剂量皮质类固醇和环磷酰胺。两名患者存活至出院。ECMO允许在难治性呼吸衰竭的情况下进行AIP诊断和治疗，从而减少了两例患者呼吸机引起的肺损伤，并架起了肺恢复的桥梁。如果怀疑难治性呼吸衰竭有AIP，应考虑ECMO转诊。
Acute interstitial pneumonia (AIP) is a rare idiopathic interstitial lung disease with rapid progressive respiratory failure and high mortality. In the present report, three cases of AIP complicated by refractory respiratory failure supported with extracorporeal membrane oxygenation (ECMO) are presented. One male and two female patients (ages 27-59) were included. Venovenous ECMO support was provided using miniaturized systems, with two-site femoro-jugular circuit configuration. Despite lung protective ventilation, prone position and neuromuscular blockade, refractory respiratory failure of unknown etiology supervened (ratio of arterial oxygen partial pressure to fractional inspired oxygen 46-130) and ECMO was initiated after 3-7 days of mechanical ventilation. AIP diagnosis was established after exclusion of infectious and noninfectious acute respiratory distress syndrome on the basis of clinical and analytical data, bronchoalveolar lavage analysis and lung imaging, with a confirmatory surgical lung biopsy revealing diffuse alveolar damage of unknown etiology. Immunosuppressive treatment consisted in high-dose corticosteroids and cyclophosphamide in one case. Two patients survived to hospital discharge. ECMO allowed AIP diagnosis and treatment in the presence of refractory respiratory failure, therefore reducing ventilator-induced lung injury and bridging lung recovery in two patients. ECMO referral should be considered in refractory respiratory failure if AIP is suspected.