肺部管理和ECLS的断奶方面的进展
Keith A Thatch1, David W Kays1
1Department of Pediatric Surgery, John Hopkins All Children's Hospital, St. Petersburg, FL, USA.
Seminars in pediatric surgery
|October 22, 2023
概括
身体外膜氧化 (ECMO) 支持新生儿和患有呼吸衰竭的儿童的肺部恢复. 仔细监测和量身定制的呼吸器设置有助于愈合,辅助疗法改善了结果.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 支持心肺血管的支持.
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 新生儿和儿科呼吸衰竭需要先进的肺部恢复支持.
- 身体外膜氧化 (ECMO) 提供气体交换,以促进可逆性肺部疾病的愈合.
- 儿科ECLS专家使用ECMO管理中的各种策略和进展.
研究的目的:
- 为儿童呼吸衰竭提供ECMO策略和进展的全面概述.
- 讨论ECMO期间肺部恢复的关键监测参数和呼吸机设置.
- 突出增强儿科ECMO患者肺部恢复的辅助疗法.
主要方法:
- 持续监测ECMO患者,包括连续血液气体,放射学和近红外光谱学 (NIRS).
- 密切观察ECLS流速,扫气体和膜肺功能.
- 针对新生儿和儿科的特殊肺恢复呼吸装置的应用.
主要成果:
- 最佳的氧气输送 (SvO2>65%) 和二氧化碳去除 (PaCO2 40-45 mmHg) 是有效的ECMO支持的关键指标.
- 特定的新生儿和儿科呼吸机设置旨在保持无毒压力和氧气水平的同时保持肺部休息.
- 附加疗法包括表面活性剂,肺清除,iNO和易感定位显著影响恢复.
结论:
- 通过提供必要的气体交换和允许量身定制的肺保护性呼吸器策略,ECMO有助于肺恢复.
- 密切监测和ECMO参数的适当调整对于成功的患者结局至关重要.
- 优化ECMO设置和辅助疗法的组合对于最大限度地恢复肺部并使奶成功至关重要.
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