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静脉肺动脉体外生命支持 (VPa ECMO):一种针对阻燃性低氧症的新策略,使VV ECMO复杂化
Leonardo Alberto Salazar-Rojas1, Dafna Isvevia García Gómez1, Yuri Valentina Pinzon Martinez1
1From the ECMO and VAD program, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia.
毒性体外膜氧化 (VV ECMO) 可能导致耐火性低氧化症. 切换到静脉肺外体膜氧化 (VPa ECMO) 改善了氧气水平,并在COVID-19患者中减少了镇静作用.
科学领域:
- 心血管医学 心血管医学
- 肺部医学 肺部医学
- 关键护理医学 关键护理医学
背景情况:
- 在毒性体外膜氧化 (VV ECMO) 期间的耐火性低氧症 (RH) 限制了治疗效益.
- 这需要深度镇静,并延迟康复.
- 替代ECMO配置可能会改善氧气输送.
研究的目的:
- 评估切换到静脉肺外体膜氧化 (VPa ECMO) 在镇静停止期间对氧化的影响.
- 评估VPa ECMO对COVID-19和RH患者的镇静要求和内支持的影响.
主要方法:
- 对41名COVID-19患者的回顾性分析,这些患者接受了RH的VV ECMO.
- 患者被切换到VPa ECMO,恢复了肺动脉的流量.
- 评估了氧化,ECMO流量,镇静水平 (里士满刺激镇静量表) 和内热支持 (LVIS分数).
主要成果:
- 动脉氧气压 (PaO2) 从68升至112.3mm Hg (p=0.001) 显著增加.
- 减少了ECMO流量 (5.7至4.8L/m;p=0.001).
- 深度镇静降低 (RASS ≤3, 37%至 63%; p=0.007) 和内热支持需求较低 (LVIS得分为4.7至1.1; p=0.005).
- 出院生存率为54%,持续的好处达到了第79天.
结论:
- 从VV ECMO切换到VPa ECMO有效地改善了RH患者的动脉氧气压.
- 这一策略有助于缓解镇静剂的取消,并减少了对内支持的需求.
- 在VV ECMO患者中,VPa ECMO可能是治疗耐火性低氧症的可行替代方案.
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