気胸を合併した重症喘息発作の蘇生, ICU管理症例の考察

抄録

In this report, a resuscitated case of 54 year old female who developed the pneumothorax following the asthmatic attack and led to acute asphyxic state was described in detail.
At first, the dangerous course to acute asphyxic death resulted in regarding the psychosomatic factors seriously and the withdrawal of steroid hormone. The general conservative treatment for the attack of serious bronchial asthma was done. But this attack became very serious because of the rupture of the alveolar wall caused by the increase of intrapulmonary pressure. In this circumstance, it is an only lifesaving method to do the controlled ventilation and bronchopulmonary lavage under the intratracheal intubation as the limit to conservative treatment. Therefore the prolonged respiratory management in ICU is needed to release the airway resistance rised. In this case, the control of the continuous oxygen humidification therapy, the maintenance of acid-base balance and the administration of some neuromuscular blocking agent and sedativa during mechanical ventilation were required. In addition, the importance of nutrition must be emphasized during the management of long time intensive respiratory therapy. The patient was succeeded in lifesaving after prolonged respiratory management such as controlled respiration for six days and assisted respiration continuously under the tracheotomy done in the third day, though the movement of extremities were disturbed. And her consciousness was recovered in half a month. It is known that the sitting position are more comfortable to patient than supine in asthmatic attack. This fact was confirmed in this case by the data of both the respiratory and circulatory functions.