侵入性机械通风中的潮体积与患有体外膜氧化症儿童的死亡率之间的关联
Jennifer Guijarro1, Jaime Fernández-Sarmiento1, Lorena Acevedo1
1From the Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia.
概括
在身体外膜氧化 (ECMO) 儿童机械通风 (MV) 期间使用低潮量 (<4毫升/公斤) 与死亡率增加和通风持续时间延长有关. 对于需要MV的儿科ECMO患者来说,常规的潮体积 (4-8毫升/公斤) 可能更安全.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 呼吸系统生理学 呼吸系统生理学
- 身体外生命支持器
背景情况:
- 机械通风 (MV) 策略对于在体外膜氧化 (ECMO) 的儿科患者来说并不成熟.
- 在ECMO期间最大限度地减少肺损伤的最佳呼吸系统参数尚不清楚.
- 了解不同潮体积的影响对于改善结果至关重要.
研究的目的:
- 调查低潮量 (LTV) 与常规潮量 (CTV) 之间的关联,以及在ECMO启动时接受MV的儿科患者的医院死亡率.
- 评估潮体积策略与ECMO后的MV持续时间之间的关系.
- 评估基于潮体积策略的纤维支气管镜等手术的需要.
主要方法:
- 回顾性队列研究包括101名儿科患者.
- 在ECMO发病时接受LTV (<4毫升/公斤) 与CTV (4-8毫升/公斤) 的患者的比较.
- 统计分析以确定死亡率和其他结果的调整几率比率 (aOR),控制混因素.
主要成果:
- LTV与医院死亡率的几率显著增加有关 (aOR: 2.45; p=0.03).
- 在ECMO脱后,在LTV的患者经历了更长的MV持续时间.
- 与LTV组相比,CTV组需要更少的纤维支气管镜检查 (aOR:0.38;p=0.04).
结论:
- 在机械通风儿童的ECMO支持开始时,潮体积低于4毫升/千克与较高的死亡率有关.
- LTV策略可能会导致延长脱后通风和增加对侵入性手术的需求.
- 儿科ECMO患者的肺保护性通风策略应考虑潮体积,以优化呼吸机制并预防肺损伤.
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