체외생명보조를 이용한 중증 급성호흡곤란증후군 치료 1예

A Case of Severe Acute Respiratory Distress Syndrome Treated with Extracorporeal Life Support

  • 김영묵 (한림대학교 의과대학 내과학교실 및 폐연구소) ;
  • 이주용 (한림대학교 의과대학 내과학교실 및 폐연구소) ;
  • 이명구 (한림대학교 의과대학 내과학교실 및 폐연구소) ;
  • 이창률 (한림대학교 의과대학 내과학교실 및 폐연구소) ;
  • 김고운 (한림대학교 의과대학 내과학교실 및 폐연구소) ;
  • 손경민 (한림대학교 의과대학 내과학교실 및 폐연구소) ;
  • 양하나 (한림대학교 의과대학 내과학교실 및 폐연구소) ;
  • 김대용 (한림대학교 의과대학 내과학교실 및 폐연구소) ;
  • 최현희 (한림대학교 의과대학 내과학교실 및 폐연구소) ;
  • 김형수 (한림대학교 의과대학 흉부외과학교실)
  • Kim, Young Mook (Department of Internal Medicine, Hallym University School of Medicine) ;
  • Lee, Jue Yong (Department of Internal Medicine, Hallym University School of Medicine) ;
  • Lee, Myung-Goo (Department of Internal Medicine, Hallym University School of Medicine) ;
  • Lee, Chang Youl (Department of Internal Medicine, Hallym University School of Medicine) ;
  • Kim, Go Woon (Department of Internal Medicine, Hallym University School of Medicine) ;
  • Sohn, Kyoung Min (Department of Internal Medicine, Hallym University School of Medicine) ;
  • Yang, Ha Na (Department of Internal Medicine, Hallym University School of Medicine) ;
  • Kim, Dae Yong (Department of Internal Medicine, Hallym University School of Medicine) ;
  • Choi, Hyun Hee (Department of Internal Medicine, Hallym University School of Medicine) ;
  • Kim, Hyoung Soo (Department of Thoracic and Cardiovascular Surgery, Hallym University School of Medicine)
  • 투고 : 2007.09.28
  • 심사 : 2007.11.01
  • 발행 : 2007.12.30

초록

중증급성호흡곤란증후군으로 전원 된 41세 여자환자를 기존의 기계환기 방법으로 치료했으나 저산소증이 호전되지 않아 내원 후 3시간 내에 신속한 체외생명보조를 시행하여 성공적으로 치료한 예를 경험하여 문헌고찰과 함께 보고하는 바이다.

The incidence of acute respiratory distress syndrome (ARDS) has been estimated worldwide to range from 1.7 to 75 cases per 100,000. There are many treatments for ARDS, but only the low tidal volume strategy is based on strong clinical evidence from randomized clinical trials. The efficacy of extracorporeal life support (ECLS) in adults remains controversial. Ongoing clinical trials and research have shown a benefit for its use to salvage severe ARDS patients that are in failure with conventional treatment. We encountered a 41-year-old woman who developed ARDS induced by pneumococcal pneumonia. Despite conventional mechanical ventilation in the emergency room, severe hypoxia remained. We treated the patient immediately with ECLS. The patient has almost fully recovered, and was discharged from a 177-day stay at our hospital.

키워드

참고문헌

  1. Wheeler AP, Bernard GR. Acute lung injury and the acute respiratory distress syndrome: a clinical review. Lancet 2007;369:1553-64 https://doi.org/10.1016/S0140-6736(07)60604-7
  2. Hemmila MR, Napolitano LM. Severe respiratory failure: advanced treatment options. Crit Care Med 2006;34: S278-90 https://doi.org/10.1097/01.CCM.0000233788.96388.D8
  3. Zapol WM, Snider MT, Hill JD, Fallat RJ, Bartlett RH, Edmunds LH, et al. Extracorporeal membrane oxygenation in severe acute respiratory failure: a randomized prospective study. JAMA 1979;242:2193-6 https://doi.org/10.1001/jama.242.20.2193
  4. Morris AH, Wallace CJ, Menlove RL, Clemmer TP, Orme JF Jr, Weaver LK, et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal $CO_2$ removal for acute respiratory distress syndrome. Am J Respir Crit Care Med 1994;149:295- 305 https://doi.org/10.1164/ajrccm.149.2.8306022
  5. Hemmila MR, Rowe SA, Boules TN, Miskulin J, McGillicuddy JW, Schuerer DJ, et al. Extracorporeal life support for severe acute respiratory distress syndrome in adults. Ann Surg 2004;240:595-607
  6. Peek GJ, Clemens F, Elbourne D, Firmin R, Hardy P, Hibbert C, et al. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure. BMC Health Serv Res 2006;6:163 https://doi.org/10.1186/1472-6963-6-163
  7. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149:818-24 https://doi.org/10.1164/ajrccm.149.3.7509706
  8. Scientific Subcommittee for National Survey of Acute Respiratory Distress Syndrome in Korean Academy of Tuberculosis and Respiratory Disease. The national survey of acute respiratory distress syndrome in Korea. Tuberc Respir Dis 1997;44:25-43 https://doi.org/10.4046/trd.1997.44.1.25
  9. The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med 2006;354:1671-84 https://doi.org/10.1056/NEJMoa051693
  10. Amato MB, Barbas CS, Medeiros DM, magaldi RB, Schettino GP, Lorenzi-Filho G, et al. Effect of a protective- ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998;338: 347-54 https://doi.org/10.1056/NEJM199802053380602
  11. ARDS Clinical Trials Network. Ventilation with lower tidal volumes as compared with traditional tidal volumesfor acute lung injury and acute respiratory distress syndrome. N Engl J Med 2000;342:1301-8 https://doi.org/10.1056/NEJM200005043421801
  12. Bartlett RH, Roloff DW, Cornell RG, Andrews AF, Dillon PW, Zwischenberger JB. Extracorporeal circulation in neonatal respiratory failure: a prospective randomized study. Pediatrics 1985;76:479-87
  13. Kopp R, Dembinski R, Kuhlen R. Role of extracorporeal lung assist in the treatment of acute respiratory failure. Minerva Anestesiol 2006;72:587-95