Extracorporeal membrane oxygenation for acute respiratory distress syndrome caused by acute phosgene poisoning: a report of 4 cases / 中华危重病急救医学

ABSTRACT

Objective? ? To? evaluate? the? protective? effect? and? curative? effect? of? early? treatment? with?extracorporeal?membrane?oxygenation?(ECMO)?in?severe?patients?with?acute?respiratory?distress?syndrome?(ARDS)?caused?by?acute?phosgene?poisoning.? Methods? The?course?of?treatment?of?4?cases?of?ARDS?caused?by?acute?phosgene?poisoning?admitted?to?intensive?care?unit?(ICU)?of?Jiangxi?Provincial?People's?Hospital?in?April?2018?was?retrospectively?analyzed.?The?treatment?parameters?in?patients?before?and?after?the?ECMO?treatment?at?1,?3,?7?days?were?collected,?including?pH?of?the?arterial?blood,?arterial?partial?pressure?of?carbon?dioxide?(PaCO2),?arterial?partial?pressure?of?oxygen?(PaO2),?blood?lactic?acid?(Lac)?and?systemic?vascular?resistance?index?(SVRI),?cardiac?index?(CI),?extravascular?lung?water?index?(ELWI),?plateau?pressure?(Pplat),?positive?end-expiratory?pressure?(PEEP),?driving?pressure?(&Delta;P),?and?acute?physiology?and?chronic?health?evaluation?Ⅱ?(APACHE?Ⅱ),?the?length?of?ICU?stay,?the?treatment?duration?of?ECMO?and?the?duration?of?mechanical?ventilation.? Results? After?admitted?in?hospital,?the?4?patients?were?all?put?on?tracheal?intubation?and?ventilator,?but?the?ventilator?support?conditions?were?high,?the?oxygenation?and?internal?environment?were?unstable.?Therefore,?ECMO?therapy?was?performed?on?the?next?day?after?admission.?Oxygenation?was?improved?obviously?after?treatment,?ventilator?support?conditions?could?be?obviously?reduced,?including?3-6?mL/kg?of?the?small?tidal?volume,?8-10?cmH2O?(1?cmH2O?=?0.098?kPa)?of?the?PEEP,?0.30?of?the?inhaled?oxygen?concentration?(FiO2),?and?other?lung?protection?rest?strategies.?The?parameters?were?improved?obviously?after?the?ECMO?treatment?compared?with?before,?from?the?1st?day?after?the?ECMO?treatment,?PaO2,?SVRI?rose?obviously,?Lac,?ELWI,?Pplat,?PEEP,?&Delta;P,?APACHEⅡ?were?significantly?decreased?[PaO2??(mmHg,?1?mmHg?=?0.133?kPa)?85.5±10.7?vs.?54.2±4.5,?SVRI?(kPa·s·L-1·m-2)?153.6±9.4?vs.?118.0±12.6,?Lac?(mmol/L)?2.15±0.19?vs.?4.93±0.96,?ELWI?(mL/kg)?17.73±2.99?vs.?20.45±4.13,?Pplat?(cmH2O)?19.25±2.21?vs.?35.75±2.22,?PEEP?(cmH2O)?9.0±1.2?vs.?13.5±1.7,?&Delta;P?(cmH2O)?10.25±1.26?vs.?22.25±3.86,?APACHEⅡ?17.25±2.22?vs.?26.50±2.08,?all?P?﹤0.05];?pH?and?CI?were?significantly?increased?after?3?days?treatment,?and?PaCO2?was?significantly?decreased?[pH?7.43±0.05?vs.?7.21±0.13,?CI?(mL·s-1·m-2)?? 64.35±3.17?vs.?59.51±3.17,?PaCO2?(mmHg)?42.0±2.2?vs.?55.0±8.5,?all?P?<?0.05].?All?the?4?patients?were?treated?successfully?and?discharged?after?improvement.?The?length?of?ICU?stay?was?8-27?days,?with?an?average?(13.5±9.0)?days;?the?treatment?duration?of?ECMO?was?6-12?days,?with?an?average?(8.0±2.7)?days;?the?duration?of?mechanical?ventilation?was?6-20?days,?with?an?average?(10.75±6.19)?days.? Conclusion? Early?treatment?with?ECMO?can?significantly?improve?the?oxygenation?of?severe?ARDS?caused?by?acute?phosgene?poisoning,?eliminate?excessive?CO2?in?the?body,?reduce?ventilator-associated?lung?injury,?and?improve?the?prognosis.