与COVID-19相关的ARDS中长期ECMO相关的结果:一个单一中心的经验
Purav Shah1, Casey Miller2, Gustavo Parilla2
1Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, McKelvey Lung Transplant Center, Emory University School of Medicine, Atlanta, USA.
Perfusion
|November 16, 2023
概括
长时间的静脉静脉外体膜氧化 (V-V ECMO) 治疗COVID-19急性呼吸困扰综合征 (ARDS) 的结果与较短的持续时间相似. 仔细的患者选择可能会证明扩展V-V ECMO支持是合理的.
科学领域:
- 关键护理医学 关键护理医学
- 支持心肺血管的支持.
- 呼吸系统衰竭管理
背景情况:
- 随着COVID-19大流行,急性呼吸困难综合征 (ARDS) 的静脉静脉外体膜氧化 (V-V ECMO) 使用量增加.
- 与其他原因相比,COVID-19 ARDS通常需要更长的V-V ECMO支持.
- 在COVID-19患者中评估长期V-V ECMO的结果至关重要.
研究的目的:
- 评估COVID-19 ARDS患者的结果,需要长时间的V-V ECMO支持 (>50天).
- 为了比较扩展V-V ECMO运行的无移植生存率,死亡率和出院率.
主要方法:
- 在V-V ECMO.上对COVID-19 ARDS患者的单中心回顾性审查.
- 分析的重点是需要V-V ECMO超过50天的患者.
- 评估的结果包括无移植生存率,死亡率和出院率.
主要成果:
- 在一个由18名患者组成的队列中,V-V ECMO持续时间的中位数为84天 (IQR 55-106) (平均年龄为48岁,男性为72%).
- 61%的人患有右心室功能障碍,72%的人患有肺胸.
- 死亡率为33% (6/18),其中61% (11/18) 被出院,其中3人需要肺移植.
结论:
- 延长COVID-19 ARDS的V-V ECMO可以产生与更短的支持持续时间相比的结果.
- 在精心挑选的患者中,扩展V-V ECMO可能是合理的,取决于资源的可用性.
- 这表明长期V-V ECMO在治疗COVID-19严重呼吸衰竭方面可能发挥作用.
相关概念视频
01:29Acute Respiratory Failure-V
142
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...
142
01:23Acute Respiratory Failure-IV
159
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...
159
01:21Acute Respiratory Failure-II
243
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:
243
01:21Acute Respiratory Failure-I
216
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,...
216