关于机械通风在体外膜氧化过程中的国际调查
Olivier van Minnen1, Floris E J Jolink, Walter M van den Bergh
1From the Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
概括
机械通风策略用于体外膜氧化 (ECMO) 在全球范围内有所不同. 大多数中心优先考虑肺部休息,使用受控通风,镇静和神经肌肉阻塞,特别是毒性ECMO.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统疗法 呼吸系统疗法
- 支持心肺血管的支持.
背景情况:
- 对于体外膜氧化 (ECMO) 患者,最佳的机械通风策略尚未明确定义.
- 目前的ECMO通风实践在全球存在显著的变化.
研究的目的:
- 调查和报告全球成年ECMO中心使用的当前机械通风策略.
- 在ECMO支持期间确定通风管理的常见做法和变化.
主要方法:
- 使用基于互联网的工具进行了一项国际,多中心,匿名,横截面的调查.
- 从北美,欧洲,亚洲和大洋洲的体外生命支持组织 (ELSO) 目录中招募了参与者.
- 从48个成年ECMO中心收集数据.
主要成果:
- 调查中有一半的中心为ECMO制定了专门的通风协议.
- 压力控制通风是有毒ECMO (VV-ECMO) 和静脉ECMO (VA-ECMO) 的首选初始模式.
- 肺部休息是VV-ECMO (93%) 的首要目标,利用神经肌肉阻塞 (93%) 和倾斜定位 (74%);自发通风是后来引入的.
- VA-ECMO的策略不太关注肺部保护,更早地过渡到自发通风.
- 四分之一的中心在3天内停止镇静.
结论:
- 在ECMO支持期间的通风策略显示出相当大的国际差异.
- 最初的管理通常涉及控制的通风,以使肺休息,经常与镇静和神经肌肉阻塞.
- "清醒ECMO"或部分神经肌肉阻塞的早期应用并不常见.
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