在体外膜氧化支持期间气管切除术的安全性:单中心体验
Marco Morosin1, Alessia Azzu1, Alexios Antonopoulos1
1Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK.
Artificial organs
|August 23, 2023
概括
在体外膜氧化 (ECMO) 期间进行皮肤通道气管切除术是安全的,可以减少ECMO的持续时间和住院时间. 这种方法与外科气管切除术可比,即使在COVID-19患者中也是如此.
科学领域:
- 临界护理医学 临界护理医学
- 支持心肺血管的支持.
- 航空航道管理的管理.
背景情况:
- 身体外膜氧化 (ECMO) 是严重呼吸和心力衰竭的生命支持措施.
- 在ECMO期间需要长时间机械通风的患者可能会从早期气管切除术中受益.
- 在ECMO患者中,气管切除术的安全性需要进一步调查.
研究的目的:
- 评估ECMO接受气管切除术的患者的安全性和结果.
- 为了在这个人群中比较皮穿式与外科气管切除术.
- 评估早期气管切除术对临床结果的影响.
主要方法:
- 追溯的,单中心的观察性研究.
- 对109名在毒性ECMO (V-V ECMO) 期间接受气管切除术的患者进行分析.
- 皮穿式 (n=76) 和外科 (n=33) 气管切除组的比较,包括COVID-19患者.
主要成果:
- 皮肤穿透式气管切除与外科手术气管切除相比,ECMO持续时间和ECMO至气管切除的时间显著缩短.
- 在穿皮和外科气管切除术之间没有观察到重大出血或生存率的显著差异.
- 早期气管切除术 (在ECMO启动后10天内) 与更短的住院时间和V-V ECMO持续时间相关.
- COVID-19患者没有表现出更高的重大出血率,不论是气管切除术类型.
结论:
- 在ECMO过程中,穿皮和外科气管切除术都在出血风险和死亡率方面安全.
- 透皮气管切除术可能在减少ECMO和住院时间方面提供优势.
- 穿皮气管切除术是ECMO患者,包括COVID-19患者手术气管切除术的可行和安全替代方案,前提是有足够的专业知识.
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