静脉动脉ECMO支持心脏性休克期间的氧化管理:一个多中心回顾性队列研究
Hadrien Winiszewski1,2, Thibault Vieille3, Pierre-Grégoire Guinot4
1Service de réanimation médicale, CHU Besançon, Besançon, France. hwiniszewski@chu-besancon.fr.
Annals of intensive care
|April 10, 2024
概括
高氧化症在静脉动脉外体膜氧化 (VA ECMO) 中常见,用于心脏性休克. 在前三天,较高的氧气水平 (FSO2和PaO2) 与急症室死亡率的增加有关.
科学领域:
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
- 生物医学工程 生物医学工程
背景情况:
- 高氧化症常见于因心脏性休克而接受静脉动脉外体膜氧化 (VA ECMO) 的患者,往往导致不良结果.
- 在VA ECMO期间氧化的实际管理策略仍未得到充分研究.
研究的目的:
- 在VA ECMO的前7天描述氧化参数,包括扫气氧分数 (FSO2),氧化器后的氧气部分压力 (PPOSTO2),灵感氧分数 (FIO2) 和放射性动脉氧气部分压力 (PaO2).
- 评估这些氧化参数与患者治疗结果之间的关联.
主要方法:
- 这是一项回顾性多中心研究,涉及法国和瑞士15个ECMO中心的139名患者.
- 收集的数据包括从VA ECMO支持的第1天到第7天的每日氧化参数 (FSO2,PPOSTO2,FIO2,PaO2).
- 接受体外心肺复苏的患者被排除在外.
主要成果:
- 中位数FSO2 (平均一至七天) 是70%. 年度VA-ECMO病例数较少的中心更有可能保持FSO2≥70%.
- 辐射PaO2 (平均1-7天) 的中位数为114 mmHg,从第1天到第3天下降. 严重的高氧化症 (PaO2 ≥300 mmHg) 在12%的患者中发生.
- PPOSTO2监测是不常见的 (28%的患者),但表明显著的高氧化症 (中位数为198mmHg).
结论:
- 在接受VA ECMO治疗的心脏性休克患者中,在最初几天 (1-3日) 中,更高的FSO2和PaO2独立地与增加的ICU死亡率有关.
- 有限的PPOSTO2监测表明频繁的高氧化症,突出了VA ECMO中优化氧气管理策略的需要.
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