Achieving a popliteal venous access for renal replacement therapy in critically ill COVID-19 patient in prone position
Achieving a popliteal venous access for renal replacement therapy in critically ill COVID-19 patient in prone position
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DOI：
10.1016/j.jvscit.2020.04.003
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发表时间：
2020-06-01
影响因子：
--
通讯作者：
Mousa, Albeir Y.
中科院分区：
文献类型：
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作者：
Adams, Elliot;Mousa, Albeir Y.
患者为67岁男性，最初以新冠肺炎继发的急性呼吸衰竭为首发症状。在到达我们的设施后不久，患者失代偿，出现严重的急性呼吸窘迫综合征，需要插管和俯卧位以维持足够的氧合。在接下来的几天里，出现了急性肾损伤，伴有少尿和严重的容量超负荷。咨询血管外科服务以获得中心静脉通路，以进行紧急持续肾脏替代治疗。在检查时，病人在旋转俯卧位床上被镇静和瘫痪。他不能在不立即缺氧和失代偿的情况下仰卧。一个50厘米长的Permcath(美敦力，圣罗莎，加利福尼亚州)被插入左静脉。此病例报告概述了血管干预者在处理俯卧位呼吸受损的新冠肺炎患者时可能遇到的具有挑战性的情景。
This patient is a 67-year-old man who initially presented to our facility with acute respiratory failure secondary to COVID-19. Soon after arrival at our facility, the patient decompensated, developing severe acute respiratory distress syndrome requiring intubation and prone positioning to maintain adequate oxygenation. During the next few days, acute kidney injury with oliguria and severe volume overload developed. The vascular surgery service was consulted to obtain central venous access for emergent continuous renal replacement therapy. On examination, the patient was sedated and paralyzed in a rotating prone-positioning bed. He could not be positioned supine without immediately becoming hypoxic and decompensating. A 50-cm Permcath (Medtronic, Santa Rosa, Calif) was inserted through the left popliteal vein. This case report outlines a possible challenging scenario that the vascular interventionist may encounter in dealing with COVID-19 patients with respiratory compromise in the prone position.