呼吸不全と関連症状のある成人のための体外生命維持装置: レビュー
Daniel Brodie1,2, Arthur S Slutsky3,4, Alain Combes5,6
1Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York.
JAMA
|August 14, 2019
まとめ
身体外生命維持 (ELS) は,急性呼吸器不全の成人のために,技術的進歩と増加する証拠によってますます受け入れられています. ELSは現在,特定の患者集団における重症治療と臓器支援の有効な選択肢です.
科学分野:
- 心血管と呼吸器系
- クリティカル ケア 医療
- 医療技術
背景:
- 急性呼吸器不全の成人の体外生命維持装置 (ELS) の使用は増加しているが,熱意はしばしば証拠を上回っている.
- 1970年代と1990年代の過去の臨床試験では,ELSの利点が示されず,その使用が制限されました.
- 技術の進歩により,ELSの安全性と有効性が向上しました.
研究 の 目的:
- 成人の急性呼吸器不全の管理における体外生命維持器の進化する役割と受け入れ方を評価する.
- 最近のデータと技術の進歩がELSに関する臨床実践にどのように影響を与えているかを評価する.
- 集中治療における ELS の拡大の兆候を探求する.
主な方法:
- 過去の臨床試験とELSの採用への影響のレビュー
- 2009年のRCTと2009年のH1N1インフルエンザのパンデミックを含む,ELSの関心に影響を与えた主要なイベントの分析.
- 重度のARDSにおける2018年のRCTの検討,その後のベイジアン分析,およびメタ分析.
主要な成果:
- 初期の試験ではELSの利点が示されませんでしたが,技術的改善により安全性が向上しました.
- 2018年のRCTでは,重度のARDSでの死亡率の減少が示されましたが,ポストホック分析では利益が示唆されました.
- 肺移植や肺血管疾患において ELSは受容可能な臓器サポートと考えられています.
結論:
- 急性呼吸器不全における 身体外生命維持器の役割は 技術の進歩と証拠によって再定義されています
- 将来のELSの開発は,技術革新とより深い生理学的理解から生じるでしょう.
- ELSは 複雑な呼吸器や心臓疾患の 管理の不可欠な部分になっています
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