在ICU接受体外膜氧化治疗的COVID-19患者的血流感染:观察性队列研究
Simone Carelli1, Antonio Maria Dell'Anna1, Luca Montini2
1Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Heart & lung : the journal of critical care
|August 10, 2023
概括
血流感染 (BSI) 在ECMO治疗的COVID-19患者中很常见,但不会使结果恶化. 主要的BSI通常是阳性,而次要的BSI通常是阴性.
科学领域:
- 传染性疾病 传染性疾病
- 关键护理医学 关键护理医学
- 病毒学 病毒学
背景情况:
- 需要体外膜氧化 (ECMO) 的COVID-19患者面临着在医院获得感染的显著增加风险.
- 了解这些感染对于改善患者管理和治疗结果至关重要.
研究的目的:
- 在ECMO治疗期间调查COVID-19患者血流感染 (BSI) 的发生率,临床结果和微生物特征.
- 确定与BSI发展和死亡率相关的因素.
主要方法:
- 从2020年3月到2022年3月,在意大利的ICU中进行了一项观察性前性队列研究.
- 68名连续接受静脉ECMO治疗的COVID-19患者被纳入.
- 收集了有关感染发展,临床过程和微生物学发现的数据.
主要成果:
- 44%的患者患有BSI (32个事件/1000个ECMO天). 较长的ECMO持续时间与较高的负债表比率有关.
- 整体ECMO和ICU死亡率分别为50%和59%,BSI和非BSI组之间没有显著差异.
- 主要的BSI主要是格拉姆阳性 (例如,Enterococcus faecalis),而次要的BSI更经常是格拉姆阴性 (例如,Acinetobacter baumannii,Pseudomonas aeruginosa).
- 对SARS-CoV-2的抗病毒治疗与ICU死亡率降低相关.
结论:
- 血流感染是ECMO治疗COVID-19患者的常见并发症,但似乎没有恶化该队列的整体临床结果.
- 在初级和二级血流感染之间观察到不同的微生物特征.
- 进一步研究在这个脆弱人群中预防策略和针对BSI的向治疗是有必要的.
相关概念视频
Acute Respiratory Failure-III
223
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...
223
Acute Respiratory Failure-II
272
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:
272
Acute Respiratory Failure-I
245
Acute respiratory failure is a condition characterized by the inability of the lungs to perform their primary function: gas exchange. This failure leads to insufficient oxygen levels (hypoxemia) in the blood, elevated carbon dioxide levels (hypercapnia), or both, causing critical impairment in organ function.
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
245
Acute Respiratory Failure-IV
176
Respiratory failure can manifest suddenly or gradually, characterized by a rapid decline in PaO2 and a rapid rise in PaCO2. This situation indicates a severe respiratory problem that may quickly become a life-threatening emergency. One of the early signs of hypoxemic Acute Respiratory Failure (ARF) is a change in mental status due to the brain's sensitivity to oxygen levels and changes in acid-base balance. Symptoms such as restlessness, confusion, and agitation suggest inadequate oxygen...
176
Acute Respiratory Failure-V
163
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
163
Assessment of Diffusion and Perfusion
1.0K
Understanding and evaluating diffusion and perfusion is critical in assessing a patient's respiratory and circulatory health. These processes play key roles in maintaining the body's internal environment, ensuring that tissues receive adequate oxygen while waste products are efficiently removed.
The Role of Diffusion in Respiration
Diffusion is the process by which molecules move from an area of higher concentration to an area of lower concentration. In the respiratory system, this...
The Role of Diffusion in Respiration
Diffusion is the process by which molecules move from an area of higher concentration to an area of lower concentration. In the respiratory system, this...
1.0K


