Respiratory Care for a Patient Undergoing Extracorporeal Life Support for Status Asthmaticus

氣喘重積狀態接受體外生命支持之病人的呼吸照護經驗

蘇靜華(Ching-Hua Su) ； 何于涵(Yu-Han He) ； 彭逸豪(Yi-Hao Peng)

《呼吸治療》 11卷1期 (2012/01) Pp. 45-55

https://doi.org/10.6269/JRT.2012.11.1.05

摘要

臨床上，雖有少數氣喘重積狀態之病人需要暫時使用機械通氣支持，但需更進一步使用體外生命支持的案例則屬少見。我們在此所報告的，是體外生命支持使用於此類病人的成功案例。此個案為一位有十年以上氣喘病史的年輕男性，由於氣喘發作至急診部門求醫。入院後不久，病人發生了極為嚴重的支氣管痙攣。雖然經過積極的藥物和氣管插管合併機械通氣支持，但仍然呈現嚴重的呼吸性酸中毒，進而於入院後第三天開始血壓下降，且需使用升壓劑才能維持生命。由於病人病情已無法藉傳統機械通氣維持適當的氧合和通氣作用，因此接受體外生命支持（體外膜氧合）。從病人使用機械通氣開始，到接受體外生命支持之後，我們持續採取肺保護性策略，避免肺部受到近一步的損傷。同時持續監測內生性吐氣末正壓、蓄積於肺部的氣體容積，和肺部動態性順應性；並以這些參數當做調整呼吸器設定的參考。病人於入院後第十一天成功脫離體外生命支持、第十六天成功拔除氣管內管，最後於第二十五天在沒有任何血管、肺部，和神經學併發症的情況下出院。（呼吸治療2012; 11（1）45-55）

關鍵字

體外生命支持 ； 氣喘重積狀態 ； 機械通氣

並列摘要

This paper reports a successful implementation of extracorporeal life support (ECLS) as a salvage treatment for an adult with acute, severe, and near fatal hypercapnic respiratory failure due to status asthmaticus. The patient had elevated arterial partial pressure of carbon dioxide (85 mmHg) upon admission, which deteriorated to greater than 115 mmHg with pH of 7.06 two days later. Emergency ECLS was initiated following the failure of aggressive pharmacological therapy and conventional mechanical ventilation to combat hypercapnia and the development of hypotension. Since the initiation of mechanical ventilation, we employed protective lung strategies and monitored lung mechanics including intrinsic positive end-expiratory pressure (intrinsic PEEP), trapped volume (Vtrap), and dynamic compliance. The patient was successfully weaned from ECLS and mechanical ventilation on eleventh and sixteenth days after admission, respectively. The patient was discharged on twenty-fifth day after admission without vascular, pulmonary, or neurological complications. This case illustrates the effective use of ECLS for acute hypercapnic respiratory failure resulting from status asthmaticus, and the role of protective lung ventilation strategies in such cases.

並列關鍵字

Extracorporeal Life Support ； Status Asthmaticus ； Mechanical Ventilation