Extracorporeal Membrane Oxygenation for ARDS in Adults
Extracorporeal Membrane Oxygenation for ARDS in Adults
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DOI：
10.1056/nejmct1103720
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发表时间：
2011-11-17
影响因子：
158.5
通讯作者：
Bacchetta, Matthew
中科院分区：
文献类型：
--
作者：
Brodie, Daniel;Bacchetta, Matthew
一名41岁妇女表现为严重的社区获得性肺炎球菌肺炎。胸片显示弥漫性双侧浸润，尽管适当的抗生素治疗，仍出现低氧性呼吸衰竭。她插管并开始机械通气，采用容量和压力限制的方法治疗急性呼吸窘迫综合征（ARDS）。在随后的24小时内，她的动脉氧分压（PaO(2)）降至40毫米汞柱，尽管有吸入氧分数（FIO(2)） 1.0的通气支持和20厘米水的呼气末正压（PEEP）。患者被置于俯卧位，给予神经肌肉阻滞剂，PaO未见改善(2)。重症监护专家建议开始体外膜氧合（ECMO）。
A 41-year-old woman presents with severe community-acquired pneumococcal pneumonia. Chest radiography reveals diffuse bilateral infiltrates, and hypoxemic respiratory failure develops despite appropriate antibiotic therapy. She is intubated and mechanical ventilation is initiated with a volume- and pressure-limited approach for the acute respiratory distress syndrome (ARDS). Over the ensuing 24 hours, her partial pressure of arterial oxygen (PaO(2)) decreases to 40 mm Hg, despite ventilatory support with a fraction of inspired oxygen (FIO(2)) of 1.0 and a positive end-expiratory pressure (PEEP) of 20 cm of water. She is placed in the prone position and a neuromuscular blocking agent is administered, without improvement in her PaO(2). An intensive care specialist recommends the initiation of extracorporeal membrane oxygenation (ECMO).