身体外膜氧化生理因素影响脉冲氧度和动脉氧和不一致性
Andrew Kalra1, Benjamin L Shou2, David Zhao3
1Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
The Annals of thoracic surgery
|September 25, 2023
概括
服用毒性ECMO的体外膜氧化 (ECMO) 患者面临更高的隐性低氧症风险. 血管压缩剂的使用和管策略显著影响脉冲氧度 (Spo2) 和动脉血液气体 (Sao2) 的差异.
科学领域:
- 心血管科学 心血管科学
- 关键护理医学 关键护理医学
- 生物医学工程 生物医学工程
背景情况:
- 身体外膜氧化 (ECMO) 中的血液动力学受管策略,血管压缩剂和血液溶解的影响.
- 这些因素可能导致ECMO患者脉冲氧计 (Spo2) 和动脉血液气体 (Sao2) 测量之间的差异.
研究的目的:
- 研究管策略和血管压缩剂使用对静脉动脉 (VA) 和静脉 (VV) ECMO的患者Spo2-Sao2差异的影响.
- 确定导致隐性低氧化症的因素,定义为Sao2 ≤88%与时间匹配的Spo2 ≥92%.
主要方法:
- 在高等学术中心对接受VA或VVECMO的成年患者 (≥18岁) 的回顾性分析.
- 包括Spo2-Sao2对,氧和≥70%,在10分钟内测量.
- 利用调整的线性混合效应建模来评估Spo2-Sao2差异,并结合血管压缩剂剂量等价值和其他实验室变量.
主要成果:
- 从139名VA-ECMO和88名VV-ECMO患者中检查了20053对Spo2-Sao2对.
- 隐性低氧症发生在35%的患者中,在VV-ECMO (65%) 比VA-ECMO (17%) 显著更常见.
- 中央VA-ECMO管道导致Spo2低估了Sao2的9.48%. 单流光VV-ECMO通道导致Spo2高估了Sao2的25.43%. 较高的血管压缩剂剂量加剧了这两种模式的差异.
结论:
- 与VA-ECMO患者相比,VV-ECMO患者的隐性低氧症风险更高.
- 导管策略 (中央VA-ECMO,单VV-ECMO) 和增加的血管压缩剂需求是临床相关Spo2-Sao2差异的重要贡献者.
- 这些发现强调了考虑这些因素对于ECMO患者精确的氧和监测的重要性.
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