在严重急性呼吸困扰综合征的体外膜氧化期间进行输出管的标准化方法:一项前性观察性研究
Roberto Roncon-Albuquerque1,2, Sérgio Gaião3,4, Francisco Vasques-Nóvoa5,6
1Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. rra_jr@yahoo.com.
Annals of intensive care
|September 18, 2023
概括
在体外膜氧化 (ECMO) 过程中输出患有严重急性呼吸困扰综合征 (ARDS) 的患者的输出管是安全的和可行的. 这种方法缩短了通风和ECMO的持续时间,减少了并发症,并改善了生存率.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统医学 呼吸系统医学
- 支持心肺血管的支持.
背景情况:
- 对于严重急性呼吸困扰综合征 (ARDS) 的体外氧化 (ECMO) 期间的输出管没有得到充分的研究.
- 在机械通风释放之前从ECMO中断奶是主要的策略.
- 在ECMO证书调查期间,出管的潜在好处.
研究的目的:
- 评估严重ARDS患者在ECMO期间进行输出管的标准化方法的安全性和可行性.
- 评估ECMO期间与输出管相关的临床结果.
主要方法:
- 在2个高等ECMO中心的4个ICU进行前性观察研究.
- 在6年内,包括254名患有严重ARDS的成年患者.
- 临床和气体交换标准的每日评估,在ECMO期间进行输出管外的专家验证.
主要成果:
- 21%的患者 (54/254) 在ECMO期间被抽管.
- 在ECMO期间的输出与更短的侵入性机械通风 (7 vs. 32天) 和ECMO持续时间 (12 vs. 19天) 相关.
- 降低了出血性休克的发生率 (2% vs. 11%) 和降低了全因死亡率 (OR 0.23;P=.008),但增加了深静脉血栓形成 (49% vs. 31%) 和失败的输出管 (20% vs. 6%).
结论:
- 在ECMO期间进行输出管的标准化方法在21%的严重ARDS患者中是安全的和可行的.
- 这一策略导致机械通风时间缩短,ECMO持续时间缩短,ICU停留时间缩短.
- 在ECMO期间的输出管与较少的传染性并发症和更高的医院存活率有关.
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