肥胖是否应该成为体外膜氧化支持的排除标准? 一个范围广泛的审查
Juan G Ripoll1, Marvin G Chang1, Christoph S Nabzdyk2
1From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Anesthesia and analgesia
|November 27, 2023
概括
肥胖似乎不是体外膜氧化 (ECMO) 支持的禁忌. 这次审查发现,接受ECMO治疗的肥胖和非肥胖患者的结果和并发症相似.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 关键护理医学 关键护理医学
背景情况:
- 从历史上看,肥胖一直被视为体外膜氧化 (ECMO) 的禁忌,原因是感知到的技术挑战和患者患病率的增加.
- 担忧包括血管访问的困难,更高的心脏输出需求,以及肥胖与较差健康结果的普遍关联.
研究的目的:
- 综合现有的关于接受ECMO支持的肥胖患者结果的文献.
- 评估ECMO在肥胖与非肥胖个体中的安全性和有效性,涉及各种指示和配置 (VV-ECMO,VA-ECMO).
主要方法:
- 从2003年1月到2023年3月,在主要数据库 (PubMed,Web of Science,Embase,Cochrane Library) 中使用图书馆员辅助的搜索进行了全面的范围审查.
- 包括的研究报告了需要ECMO的肥胖患者的结果. 从26个符合条件的出版物中提取和分析数据.
主要成果:
- 该审查综合了针对ARDS (COVID-19和非COVID-19) 毒性 (VV) -ECMO,静脉 (VA) -ECMO和联合VA/VV-ECMO支持的研究数据.
- 尽管回顾性设计和异质性的局限性,但研究结果表明,与接受ECMO的非肥胖患者相比,肥胖患者的结果和并发症率相等.
结论:
- 仅基于体重指数的肥胖不应作为ECMO候选人的排除标准.
- 目前的证据表明,ECMO可以在肥胖患者中安全有效地使用,这挑战了以前的假设.
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