在急性呼吸困扰综合征患者体外膜氧化支持期间的压力支通风
Benedetta Fumagalli1, Marco Giani1,2, Michela Bombino2
1From Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
概括
在静脉静脉外体膜氧化 (VV ECMO) 过渡到压力支通风 (PSV) 的严重急性呼吸困扰综合征 (ARDS) 患者是可行的. 这种切换改善了呼吸机制和血液动力学,有助于ECMO断奶和生存.
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
- 心血管生理学心血管生理学
背景情况:
- 超保护控制机械通风 (CMV) 是用于静脉静脉外体膜氧化 (VV ECMO) 的严重急性呼吸困扰综合征 (ARDS) 患者的标准,以预防肺损伤.
- 随着ARDS患者的康复,过渡到辅助呼吸可能会减少镇静和,促进从机械支中释放.
研究的目的:
- 评估将ARDS患者从VV ECMO切换到压力支通风 (PSV) 的可行性.
- 在VV ECMO期间过渡到PSV后调查呼吸机制和氧化参数的变化.
主要方法:
- 一项对191名成年ARDS患者在VV ECMO (2009-2022) 上进行的回顾性单心研究.
- 在VV ECMO期间,对131名成功从CMV转变为PSV的患者进行了分析.
- 评估呼吸系统的合规性,肺部冲刺分数,心血管顺序器官衰竭评估 (SOFA) 评分和肺动脉压力.
主要成果:
- 69%的患者在VV ECMO期间成功切换到PSV.
- 肺静脉病毒与呼吸系统符合性增加 (p=0.02) 和肺静脉分离率降低 (p<0.001) 相关.
- 观察到心血管SOFA得分的改善和肺动脉压的降低 (p<0.05). 94%的PSV患者从ECMO中断奶,90%的住院存活率.
结论:
- 压力支通风 (PSV) 是VV ECMO支持的ARDS患者可行的模式.
- 过渡到PSV可能会改善呼吸功能,血液动力学和结果,包括ECMO断奶和生存.
- 需要进一步的研究来证实PSV在这种重症患者群体中的益处.
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