介入體外膜氧合器在致命性氣喘使用機械通氣照護經驗之個案報告

The role of Extracorporeal membrane oxygenation in Near-Fatal Asthma with Mechanical Ventilation Management: A Case Report

趙大維(Ta-Wei Chao) ； 蘇煒婷(Wei-Ting Su) ； 郭弘誼(Hong-Yi Guo)

《呼吸治療》 20卷2期 (2021/07) Pp. 33-42

https://doi.org/10.6269/JRT.202107_20(2).0004

摘要

重積型氣喘會導致頑固性低血氧及通氣不足的情形發生，經由標準治療和傳統機械通氣後效果不彰進展成致命性氣喘，因此葉克膜為一項醫療急救設備。本個案為63歲男性有氣喘的過去病史且部分控制不佳，此次急性發作後轉送至本院放置氣管內管給予機械通氣支持，胸部X光在初始並無任何發炎、浸潤等變化，快速的病情進展，頑固性低血氧和酸血症經傳統治療仍改善有限，在給予鎮靜藥物後放置葉克膜，氧合與酸血症情形在幾小時內明顯改善，呼吸器設定逐漸下調，並在七天內將氣管內管成功拔除脫離呼吸器。此個案顯示葉克膜在致命性氣喘扮演重要的角色。本文將探討所有與呼吸治療相關的呼吸器設定、影像檢查、控制用藥與介入處置等，並藉由此次照顧經驗對於未來甚至疾病預防上有不一樣的思維，避免再次急性惡化。

關鍵字

氣喘 ； 致命性氣喘 ； 體外膜氧合器 ； 頑固性低血氧

並列摘要

Status asthmaticus might cause refractory hypoxemia and hypoventilation even treated after the standard therapy and conventional mechanical ventilation. Therefore, ECMO is one of rescue option to apply in the adult with near-fatal-asthma(NFA). We present a case: 63 year-old male had asthma with partial control. This time, he suffered from acute asthma attack then transfer to our ED for intubating with mechanical ventilation. Chest X-ray was normal in the beginning. However, the condition downhill rapidly and severe hypercapnia and hypoxemia after standard asthma therapy were in vein. After applying ECMO had dramatic change with improving oxygenation and normal gas exchange. Ventilator setting down gradually and the case extubate soon after 7 days then recover to almost usual health adults when discharge. This case demonstrate the important role of ECMO in NFA and we present all of the procedure include ventilator setting. Nevertheless, it also reinforces the importance of daily control of asthma and the prevention of acute exacerbation.

並列關鍵字

Asthma ； Near-Fatal Asthma(NFA) ； Extracorporeal membrane oxygenation(ECMO) ； Refractory hypoxemia