PDF(Pubmed)
Abstract：
The following case report analyses a patient with extracorporeal membrane oxygenation (ECMO), who suffered from a severe Acute Respiratory Distress Syndrome (ARDS) due to COVID-19 pneumonia. ARDS is defined as a diffuse and inflammatory injury of the lungs; classifying this as severe when the ratio of arterial oxygen tension to a fraction of inspired oxygen (PaO2/FiO2) is equal to or lower than 100 mmHg. To decide if the patient was suitable for the use of ECMO therapy, the ELSO criteria were used; and in this case, the patient matched with the criteria of hypoxemic respiratory failure (with a PaO2/FiO2 < 80 mmHg) after optimal medical management, including, in the absence of contraindications, a trial of prone positioning. During hospitalization, the patient presented a Central Diabetes Insipidus (CDI), probably explained by the damage hypoxia generated on the central nervous system. There are few reports of this complication produced by COVID-19. The case is about a 39-year-old woman, who started with ECMO 6 days after the beginning of Invasive Mechanical Ventilation (IMV), because of a severe ARDS. On the fifth day of ECMO, the patient started with a polyuria of 7 L in 24 h. A series of paraclinical studies were made, but no evidence of central nervous system lesions was found. After treatment with desmopressin was initiated and the ARDS was solved, polyuria stopped; with this, CDI was diagnosed. There are many complications secondary to the evolution of COVID-19 infection, and some of them are not yet well explained.
摘要：
以下病例报告分析了一名体外膜氧合（ECMO）患者，由于COVID-19肺炎而患有严重的急性呼吸窘迫综合征(ARDS)。ARDS被定义为肺部的弥漫性和炎症性损伤；当动脉血氧张力与吸入氧气的比例（PaO2/FiO2）等于或低于100mmHg时，将其分类为严重。为了确定患者是否适合使用ECMO治疗，使用了ELSO标准；在这种情况下，患者符合低氧性呼吸衰竭的标准（PaO2/FiO2<80mmHg），包括,在没有禁忌症的情况下,俯卧定位的试验。住院期间,患者出现了中心性尿崩症（CDI），可能是由于缺氧对中枢神经系统造成的损害。关于COVID-19引起的这种并发症的报道很少。这个案子是关于一个39岁的女人,在有创机械通气（IMV）开始后6天开始使用ECMO，因为严重的ARDS。在ECMO的第五天，患者在24小时内开始出现7L的多尿。进行了一系列临床旁研究，但是没有发现中枢神经系统病变的证据。开始去氨加压素治疗后，ARDS得到解决，多尿停止了；有了这个，CDI被诊断。有许多继发于COVID-19感染演变的并发症，其中一些还没有得到很好的解释。
