A Case Report of Extracorporeal Membrane Oxygenation and Hemadsorber Therapy in Septic Patient with Multiorgan Injury

Anna Klēšmite, Roberts Leibuss, Baiba Arklina, L. Semčenko, Mārtiņš Kalējs, E. Strīķe, P. Stradins
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Abstract

Summary Diagnostic microbiology and management of sepsis have advanced, even though the complication of multiorgan dysfunction remains a significant cause of morbidity and mortality. An estimated incidence of sepsis in 2017 is about 48 million a year, including 11 million sepsis- related deaths, which represents 19.7% of all global deaths.(1,2) Acute respiratory distress syndrome (ARDS) is a devastating complication of sepsis, conventionally, a substantial number of patients require mechanical ventilation (MV) to avert hypoxemia and hypercapnia. However, MV per se can cause lung injury, accelerating the disease progression. The use of extracorporeal membrane oxygenation (ECMO) in the management of ARDS has grown considerably in the past decade. More recently, an increasing popularity of spontaneous breathing and awake patients undergoing ECMO is seen, as well as the use of various types of hemadsorbers for reducing pathologically increased inflammatory response.(3) The purpose of this case report is to review airway and multiorgan support management during ECMO.
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脓毒症合并多器官损伤患者体外膜氧合及吸附剂治疗1例报告
尽管多器官功能障碍的并发症仍然是发病率和死亡率的重要原因,但败血症的诊断微生物学和管理已经取得了进展。据估计,2017年脓毒症的发病率约为每年4800万例,其中包括1100万例脓毒症相关死亡,占全球总死亡人数的19.7%。(1,2)急性呼吸窘迫综合征(ARDS)是脓毒症的一种破坏性并发症,通常情况下,大量患者需要机械通气(MV)来避免低氧血症和高碳酸血症。然而,MV本身可引起肺损伤,加速疾病进展。在过去的十年里,体外膜氧合(ECMO)在ARDS治疗中的应用有了显著的增长。最近,越来越多的自主呼吸和清醒的患者接受ECMO,以及使用各种类型的血液吸附剂来减少病理性增加的炎症反应。(3)本病例报告的目的是回顾ECMO期间气道和多器官支持管理。
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