需要长期体外膜氧化支持的COVID-19患者的生存和长期功能状态
María Martínez-Martínez1,2,3, Matthieu Schmidt4,5, Lars Mikael Broman6,7
1Department of Intensive Care, Vall d'Hebron University Hospital, Barcelona, Spain.
Annals of the American Thoracic Society
|December 22, 2023
概括
长期体外膜氧化 (ECMO) 的严重COVID-19ARDS患者的存活率受到年龄和清醒的ECMO策略的影响. 许多幸存者在6个月后经历了无限制的肺功能障碍.
科学领域:
- 关键护理医学 关键护理医学
- 肺部病理学 肺部病理学
- 传染性疾病 传染性疾病
背景情况:
- 严重的急性呼吸困扰综合征 (ARDS) 可能需要长时间的体外膜氧化 (ECMO) 支持 (>28天).
- 需要长期ECMO的非解决性ARDS患者的患者康复和功能状态仍然不确定,肺移植是潜在的选择.
研究的目的:
- 为了确定影响COVID-19患者生存的因素,ARDS需要ECMO超过28天.
- 描述这些重症患者的6个月功能状态.
主要方法:
- 对120名COVID-19 ARDS患者进行了回顾性,多中心,观察性队列研究,ECMO>28天.
- 多变量分析使用考克斯回归和最小绝对收缩和选择运算符 (LASSO) 进行变量选择.
- 使用增强的反向概率权重进行后期分析,以评估"清醒"的ECMO策略.
主要成果:
- 50.8%的患者存活到6个月的随访.
- 年龄和"清醒"的ECMO策略 (患者清醒,合作,接受康复/理疗) 是医院生存的预测因素.
- 6个月后,42.5%的幸存者在家中,而84.3%的幸存者不需要氧气治疗. 较长的ECMO持续时间与增加对氧疗法的需求相关.
结论:
- 需要长期ECMO的COVID-19 ARDS患者可以在可控的肺功能障碍下生存.
- 年龄和清醒的ECMO策略可能与改善的生存结果有关.
- 延长ECMO支持持续时间与在出院6个月后需要氧气治疗的可能性更高有关.
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