title: [Endobronchial treatments made possible by extracorporeal lung assist in a patient in status asthmaticus refractory to mechanical ventilation].
abstract: A 19-year-old endotracheally intubated women was admitted to our hospital in severe status asthmaticus that was not relieved by inhalation of beta 2-agonists or by epinephrine, aminophylline, or corticosteroids. A chest radiography revealed pneumomediastinum and subcutaneous emphysema. Pressure-limited mechanical ventilation at a peak airway pressure of 20--30 cmH2O failed to ventilate the lungs, and caused a left pneumothorax and atelectasis. Extracorporeal lung assist (ECLA) was begun and enabled repeated suctioning through a fiberoptic bronchoscope for more than a minute with no serious complications. During ECLA aerosol therapy with a large dose of a beta 2-agonist (procatherol 0.15 mg) increased the tidal volume with no adverse effects. Atelectatic areas of the lungs re-expanded, pulmonary function improved, and ECLA was stopped 86 hours after it had been started. We suggest that, although it is highly invasive, ECLA can be useful in patients with status asthmaticus refractory to mechanical ventilation, and can allow endobronchial suctioning to be done safely.
authors.affiliation: First Department of Internal Medicine, Kumamoto University School of Medicine, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: H
authors.initials: H
authors.lastname: Kohrogi
authors.forename: O
authors.initials: O
authors.lastname: Kawano
authors.forename: K
authors.initials: K
authors.lastname: Sakurai
authors.forename: I
authors.initials: I
authors.lastname: Kukita
authors.forename: T
authors.initials: T
authors.lastname: Sato
authors.forename: K
authors.initials: K
authors.lastname: Okamoto
authors.forename: H
authors.initials: H
authors.lastname: Terasaki
authors.forename: M
authors.initials: M
authors.lastname: Suga
authors.forename: M
authors.initials: M
authors.lastname: Ando
mesh_terms: D000293:Adolescent; D001999:Bronchoscopy; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D012121:Respiration, Artificial; D013224:Status Asthmaticus / Q000628:therapy*; D013396:Suction