呼吸衰竭和相关迹象的成年人体外生命支持:一篇综述
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
概括
由于技术进步和越来越多的证据,急性呼吸衰竭的成年人越来越接受体外生命支持 (ELS). 现在,ELS在特定患者群体的重症监护和器官支持中是一个可行的选择.
科学领域:
- 心血管和呼吸系统
- 危急护理医学
- 医疗技术
背景情况:
- 在急性呼吸衰竭的成年人中,体外生命支持 (ELS) 的使用量有所增加,但热情往往超过了证据.
- 上世纪70年代和90年代的临床试验没有证明ELS的益处,限制了其使用.
- 技术进步提高了ELS的安全性和有效性.
研究的目的:
- 评估体外生命支持在成人急性呼吸衰竭管理中的演变作用和接受.
- 评估最近的数据和技术改进如何影响ELS的临床实践.
- 探索ELS在重症监护中的指标.
主要方法:
- 历史临床试验的审查及其对ELS采用的影响.
- 影响ELS兴趣的关键事件的分析,包括2009年RCT和2009年H1N1流感大流行.
- 对严重ARDS的2018年RCT的检查,随后的贝叶斯分析和元分析.
主要成果:
- 早期的试验没有显示ELS的好处,但技术改进提高了它的安全性.
- 2018年的一项RCT显示严重ARDS的死亡率没有显著降低,但事后分析表明有好处.
- 现在ELS被认为是可接受的器官支持,在肺移植和肺血管疾病中发挥越来越大的作用.
结论:
- 通过技术进步和证据重新定义了体外生命支持在急性呼吸衰竭中的作用.
- 未来的ELS发展将源于技术创新和更深入的生理学理解.
- 电子呼吸系统正在成为治疗复杂呼吸和心脏疾病的重要组成部分.
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