要約:レジオネラ肺炎はときに重症化して治療に難渋する。我々はレジオネラ肺炎による重 症急性呼吸促迫症候群の 2 例を permissive hypoxemia を併用して救命できた。症例はいずれ も尿中抗原によりレジオネラ肺炎と診断して,レボフロキサシンを静脈内投与した。症例 1 は 59 歳男性で P/F 比は 64,症例 2 は 64 歳男性で P/F 比は 58 まで低下した。人工呼吸は圧支持換 気により吸気終末プラトー圧を 25 cmH2O 前後に保った。FIO2 は 0.6 -0.7 を目標に SpO2 88%,PaO2 50 mmHg 前後を許容した。臓器の虚血症状と代謝性アシドーシスの進行はなく, 数日で酸素化は改善傾向を示してその後抜管した。レジオネラ肺炎は,抗菌薬が奏功するま での人工呼吸管理が予後を左右する。肺保護戦略の低い気道内圧と高濃度酸素投与を回避す る permissive hypoxemia により,臓器障害を起こすことなく救命し得た。 Abstract Two cases of acute respiratory distress syndrome

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... sociated with Legionella pneumonia successfully treated with permissive hypoxemia We report 2 cases of acute respiratory distress syndrome (ARDS) associated with Legionella pneumonia successfully treated with permissive hypoxemia. The patients were diagnosed as Legionella pneumonia with detection of urinary antigen of Legionella, and treated with intravenous levofloxacin. They were mechanically ventilated with a mode of pressure support ventilation. The first case was a 59-year-old male. The P/F ratio decreased to 64 because of severe pneumonia. The second case was a 64-year-old male. The P/F ratio decreased to 58. The PEEP level was set at 13-15 cmH2O and the end-inspiratory plateau pressure was 22-25 cmH2O in both cases. We induced permissive hypoxemia of SpO2 88% and PaO2 50 mmHg to set FIO2 0.6-0.7 and to maintain airway pressure 25 cmH2O or under as lung protective strategy. No hypoxic damage of any vital organs or progressive metabolic acidosis was detected. They recovered from severe ARDS without any residual dysfunction of vital organs.