Successful extracorporeal membrane oxygenation therapy as a bridge to sequential bilateral lung transplantation for a patient after severe paraquat poisoning
Successful extracorporeal membrane oxygenation therapy as a bridge to sequential bilateral lung transplantation for a patient after severe paraquat poisoning
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DOI：
10.3109/15563650.2015.1082183
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发表时间：
2015-10-21
影响因子：
3.3
通讯作者：
Dai, Huaping
中科院分区：
文献类型：
--
作者：
Tang, Xiao;Sun, Bing;Dai, Huaping
上下文。百草枯是一种广泛使用的除草剂，可导致人类严重至致命的中毒。与呼吸衰竭相关的肺纤维化的不可逆转和快速进展是中毒后期死亡的主要原因。严重百草枯中毒的肺移植成功的报道并不多见。我们期待这一成功案例能为其他有类似情况的患者提供参考。案件详情。一名24岁女性在摄入50毫升百草枯约2小时后被送往医院。她经历了迅速加重的肺纤维化和严重的呼吸衰竭。服药后第34天，进行插管和有创机械通气。患者在第44天接受肺移植评估，静脉-静脉体外膜氧合(ECMO)被建立为通往肺移植的桥梁。第56天，她成功地接受了双侧连续肺移植。通过呼吸、身体康复和营养支持，患者于第66天脱机拔管。第80天，她出院了。术后1年随访，患者情况良好，肺功能逐渐改善。结论：肺移植可能是治疗百草枯所致终末期肺纤维化和继发性呼吸衰竭的有效方法。对于病情进展迅速，不能立即进行肺移植的患者(例如，在等待有生存能力的供者或毒物清除的同时)，ECMO应该是通往肺移植的可行桥梁。
Context. Paraquat is a widely used herbicide that can cause severe to fatal poisoning in humans. The irreversible and rapid progression of pulmonary fibrosis associated with respiratory failure is the main cause of death in the later stages of poisoning. There are infrequent reports of successful lung transplants for cases of severe paraquat poisoning. We expect that this successful case will provide a reference for other patients in similar circumstances. Case details. A 24-year-old female was sent to the hospital approximately 2 hours after ingesting 50 ml of paraquat. She experienced rapidly aggravated pulmonary fibrosis and severe respiratory failure. On the 34th day after ingestion, she underwent intubation and invasive mechanical ventilation. The patient was evaluated for lung transplantation, and veno-venous extracorporeal membrane oxygenation (ECMO) was established as a bridge to lung transplantation on the 44th day. On the 56th day, she successfully underwent a bilateral sequential lung transplantation. Through respiratory and physical rehabilitation and nutrition support, the patient was weaned from mechanical ventilation and extubated on the 66th day. On the 80th day, she was discharged. During the 1-year follow-up, the patient was found to be in good condition, and her pulmonary function improved gradually. Conclusion: We suggest that lung transplantation may be an effective treatment in the end stages of paraquat-induced pulmonary fibrosis and consequential respiratory failure. For patients experiencing a rapid progression to a critical condition in whom lung transplantation cannot be performed immediately (e.g., while awaiting a viable donor or toxicant clearance), ECMO should be a viable bridge to lung transplantation.