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[Extracorporeal membrane oxygenation for acute respiratory distress syndrome caused by acute phosgene poisoning: a report of 4 cases].
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Feb; 31(2):232-235.ZW

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 (ΔP), 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, ΔP, APACHE II 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, ΔP (cmH2O): 10.25±1.26 vs. 22.25±3.86, APACHE II: 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.

CONCLUSIONS

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.

Authors+Show Affiliations

Department of Critical Care Medicine, Jiangxi Provincial People's Hospital, Nanchang 330006, Jiangxi, China. Corresponding author: Yang Chunli, Email: ycl121@163.com.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

chi

PubMed ID

30827316

Citation

He, Zhaohui, et al. "[Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome Caused By Acute Phosgene Poisoning: a Report of 4 Cases]." Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, vol. 31, no. 2, 2019, pp. 232-235.
He Z, Yang X, Yang C. [Extracorporeal membrane oxygenation for acute respiratory distress syndrome caused by acute phosgene poisoning: a report of 4 cases]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019;31(2):232-235.
He, Z., Yang, X., & Yang, C. (2019). [Extracorporeal membrane oxygenation for acute respiratory distress syndrome caused by acute phosgene poisoning: a report of 4 cases]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 31(2), 232-235. https://doi.org/10.3760/cma.j.issn.2095-4352.2019.02.022
He Z, Yang X, Yang C. [Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome Caused By Acute Phosgene Poisoning: a Report of 4 Cases]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019;31(2):232-235. PubMed PMID: 30827316.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Extracorporeal membrane oxygenation for acute respiratory distress syndrome caused by acute phosgene poisoning: a report of 4 cases]. AU - He,Zhaohui, AU - Yang,Xiaogang, AU - Yang,Chunli, PY - 2019/3/5/entrez PY - 2019/3/5/pubmed PY - 2019/7/26/medline SP - 232 EP - 235 JF - Zhonghua wei zhong bing ji jiu yi xue JO - Zhonghua Wei Zhong Bing Ji Jiu Yi Xue VL - 31 IS - 2 N2 - 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 (ΔP), 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, ΔP, APACHE II 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, ΔP (cmH2O): 10.25±1.26 vs. 22.25±3.86, APACHE II: 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. CONCLUSIONS: 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. SN - 2095-4352 UR - https://www.unboundmedicine.com/medline/citation/30827316/[Extracorporeal_membrane_oxygenation_for_acute_respiratory_distress_syndrome_caused_by_acute_phosgene_poisoning:_a_report_of_4_cases]_ L2 - http://www.cccm-em120.com/weizhongbingguokan/31/232.pdf DB - PRIME DP - Unbound Medicine ER -