重症COVID-19患儿ecmo治疗体会(临床病例描述)

V. Mishchuk, V. Pryimakova
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引用次数: 0

摘要

总结:在感染COVID-19的儿科患者中,约0.8% - 1%需要入住重症监护病房。决定儿童重症病程和死亡率的主要综合征是急性呼吸窘迫综合征、多系统炎症综合征和多器官衰竭。在我们的报告中,我们介绍了两例成功使用ECMO治疗发生急性呼吸窘迫综合征的COVID-19儿童的临床病例。临床病例描述。3岁(病例1)和17岁(病例2)的儿童因严重呼吸衰竭的迹象被送入重症监护室。两例患者均被诊断为SARS-CoV-2病毒感染。传统的呼吸支持方法结合俯卧位通气和肌麻痹并不能改善氧合。在PaO2 / FiO2 - 60(病例1)和PaO2 / FiO2 - 75(病例2)的情况下,患儿开始V-V ECMO。两例患者ECMO持续时间均为7天。结果,脱管后氧合改善:病例1 PaO2 / FiO2 - 310(病例1),病例2 PaO2 / FiO2 - 264(病例2),以及肺力学状况(Cst从1例的8增加到22 ml / cmH2O,从2例的15 ml / cmH2O增加到57 ml / cmH2O),两例患者均存活并出院,认知功能障碍最小。结论:在传统呼吸支持方法不能消除严重ARDS所致的危重低氧血症的情况下,ECMO是一种有效的抢救技术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
EXPERIENCE OF USING ECMO IN CHILDREN WITH SEVERE COVID-19 (DESCRIPTION OF CLINICAL CASES)
Summary: Among pediatric patients with COVID-19, about 0,8-1 % require admission to the intensive care unit. The main syndromes that determine the severe course and mortality in children are acute respiratory distress syndrome, multisystem inflammation syndrome and multiple organ failure. In our report, we present two clinical cases of successful use of ECMO in children with COVID-19 who have developed acute respiratory distress syndrome. Description of clinical cases. Children aged 3 years (case 1) and 17 years (case2) were admitted to the intensive care unit with signs of severe respiratory failure. Both patients were diagnosed with SARS-CoV-2 virus infection. Traditional methods of respiratory support in combination with prone position ventilation and myoplegia have not improved oxygenation. With PaO2 / FiO2 – 60 (case 1) and PaO2 / FiO2 – 75 (case 2), children were started V-V ECMO. The duration of ECMO in both patients was 7 days. As a result, improved oxygenation was achieved: PaO2 / FiO2 – 310 (case 1), PaO2 / FiO2 – 264 (case 2) after decannulation, as well as the condition of pulmonary mechanics (Cst increased from 8 to 22 ml / cmH2O in the first case and from 15 ml / cmH2O to 57 ml / cmH2O in the second case, both patients survived and were discharged with minimal cognitive impairment. Conclusion: In cases where critical hypoxemia caused by severe ARDS is not eliminated by traditional methods of respiratory support, ECMO can be an effective rescue technology.
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