リソース制限による体外式膜型人工肺の中止
Rodrigo Cardoso Cavalcante1, Marissa Brunetti2, Jo-Ching Hsiung3
1From the Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
ASAIO journal (American Society for Artificial Internal Organs : 1992)
|January 9, 2026
まとめ
リソース制限による体外式膜型人工肺の中止（EDRL）は稀であるが、世界的に増加しており、特にCOVID-19パンデミック以降に顕著である。地域によって発生率は異なり、中南米および南西アジア/アフリカでは生存率が低い。
科学分野:
- 集中治療医学;グローバルヘルス;ヘルスシステムリサーチ
背景:
- 体外式膜型人工肺（ECMO）は、重度の心肺不全に使用される生命維持技術である。;リソースの制約によりECMOの中止が必要となる場合があり、これは稀ではあるが重大な事象である。;EDRLの疫学を理解することは、世界の健康の公平性のために不可欠である。
研究 の 目的:
- EDRLの世界的な発生率と傾向を分析する。;地理的地域ごとのEDRL率を比較する。;COVID-19パンデミック前後のEDRLの変化を評価する。
主な方法:
- 2013年から2023年までの国際的なECMOセンターのデータを対象とした後向きコホート分析を実施した。;小児および成人のすべてのECMO実施例を含めた。;EDRLイベント、診断、生存率、地域差を分析した。
主要な成果:
- ECMO実施例161,851例中312例（0.19%）がEDRLに至った。;EDRLはCOVID-19パンデミック後（1,000例あたり1.44から2.44件）に著しく増加した。;欧州と北米で不均衡な増加が見られた。;中南米および南西アジア/アフリカではEDRLの割合が高く、生存率が低かった。
結論:
- EDRLはECMOケアにおいて稀ではあるが増加している懸念事項である。;EDRLの発生率と転帰には著しい地域格差が存在する。;COVID-19パンデミックはEDRLを悪化させ、重症ケアにおけるリソース配分の課題を浮き彫りにした。
関連する概念動画
01:26Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy
173
Continuous Renal Replacement Therapy (CRRT) is an essential intervention for patients experiencing severe kidney dysfunction. This therapy offers a continuous mechanism for removing fluids and toxins from the bloodstream, leveraging the patient’s blood pressure to facilitate filtration through a specialized filter. This method contrasts with intermittent dialysis, providing a gentler and more consistent removal of waste products and excess fluid, which is particularly beneficial in...
173
01:21Acute Respiratory Failure-II
1.0K
Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
1.0K
01:25Extracorporeal Removal of Drugs: Hemoperfusion and Hemofiltration
187
Hemoperfusion and hemofiltration are critical techniques in medical treatments to eliminate accumulated drugs, metabolites, and electrolytes from the bloodstream. These methods are particularly vital in cases of accidental poisoning and drug overdose.Hemoperfusion involves passing blood through an adsorbent material to remove unwanted substances. The main adsorbents used in hemoperfusion include activated charcoal and Amberlite resins. Activated charcoal can adsorb both polar and nonpolar...
187
01:30Administering Oxygen by Mask
2.0K
Administering Oxygen by Mask
Administering oxygen by mask is a common nursing intervention that provides supplemental oxygen to patients with respiratory distress or chronic lung conditions. This procedure involves delivering oxygen at a specified rate through a face mask connected to an oxygen source.
Equipment
The equipment necessary for this procedure includes:
Administering oxygen by mask is a common nursing intervention that provides supplemental oxygen to patients with respiratory distress or chronic lung conditions. This procedure involves delivering oxygen at a specified rate through a face mask connected to an oxygen source.
Equipment
The equipment necessary for this procedure includes:
2.0K
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
1.8K
Oxygen therapy is a pivotal aspect of medical care, particularly for patients with respiratory ailments. Two prominent oxygen-delivering systems include the Venturi mask and the transtracheal oxygen catheter.
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
1.8K
01:30Acute Respiratory Failure-III
761
Hypercapnic respiratory failure, also known as Type 2 or ventilatory respiratory failure, is a severe condition characterized by the body's inability to effectively remove carbon dioxide (CO2) from the bloodstream. It leads to an arterial CO2 pressure (PaCO2) exceeding 45 mmHg and a blood pH above 7.35. This situation indicates that the body's ventilatory demand, or the ventilation needed to maintain normal PaCO2 levels, surpasses its supply or the maximum gas flow achievable without...
761