Treatment of Bronchopleural and Alveolopleural Fistulas in Acute Respiratory Distress Syndrome With Extracorporeal Membrane Oxygenation, a Case Series and Literature Review.
Treatment of Bronchopleural and Alveolopleural Fistulas in Acute Respiratory Distress Syndrome With Extracorporeal Membrane Oxygenation, a Case Series and Literature Review.
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DOI：
10.1097/cce.0000000000000393
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发表时间：
2021-05
影响因子：
--
通讯作者：
Owens RL
中科院分区：
文献类型：
--
作者：
Odish MF;Yang J;Cheng G;Yi C;Golts E;Madani M;Pollema T;Owens RL
描述急性呼吸窘迫综合征并发支气管胸膜和肺泡胸膜漏气患者的呼吸机和体外膜氧合管理策略。 2019 年至 2020 年案例系列。单一三级转诊中心——加州大学圣地亚哥分校。 4 名患者患有各种病因的急性呼吸窘迫综合征，包括流感、耐甲氧西林金黄色葡萄球菌肺炎、电子烟或电子烟产品使用相关的肺损伤以及 2019 年冠状病毒病，并发支气管胸膜和肺泡胸膜瘘以及漏气的胸管。支气管胸膜和肺泡胸膜瘘闭合并存活至出院。所有四名患者均接受体外膜肺氧合，呼吸机设置甚至低于体外生命支持组织指南推荐的超保护性肺通气。患者的支气管胸膜瘘和肺泡胸膜瘘在体外膜氧合和最小通气支持期间闭合。所有四名患者均存活并出院。对于患有急性呼吸窘迫综合征和伴有持续漏气的支气管胸膜和肺泡胸膜瘘的患者，使用体外膜氧合以允许比超保护性肺通气更低的呼吸机设置对于介导支气管胸膜和肺泡胸膜瘘的愈合是安全可行的。
To describe a ventilator and extracorporeal membrane oxygenation management strategy for patients with acute respiratory distress syndrome complicated by bronchopleural and alveolopleural fistula with air leaks. Case series from 2019 to 2020. Single tertiary referral center—University of California, San Diego. Four patients with various etiologies of acute respiratory distress syndrome, including influenza, methicillin-resistant Staphylococcus aureus pneumonia, e-cigarette or vaping product use-associated lung injury, and coronavirus disease 2019, complicated by bronchopleural and alveolopleural fistula and chest tubes with air leaks. Bronchopleural and alveolopleural fistula closure and survival to discharge. All four patients were placed on extracorporeal membrane oxygenation with ventilator settings even lower than Extracorporeal Life Support Organization guideline recommended ultraprotective lung ventilation. The patients bronchopleural and alveolopleural fistulas closed during extracorporeal membrane oxygenation and minimal ventilatory support. All four patients survived to discharge. In patients with acute respiratory distress syndrome and bronchopleural and alveolopleural fistula with persistent air leaks, the use of extracorporeal membrane oxygenation to allow for even lower ventilator settings than ultraprotective lung ventilation is safe and feasible to mediate bronchopleural and alveolopleural fistula healing.