在静脉静脉外体膜氧化中右心室损伤的定义和管理
Siddharth Pawan Dugar1,2, Ryota Sato3, Matthew Charlton4,5
1From the Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
概括
在静脉静脉外体膜氧化 (VV ECMO) 期间的右心室损伤 (RVI) 是常见的和致命的. 这次审查强调了不一致的RVI定义和缺乏向治疗方法,敦促达成共识和研究以获得更好的患者结果.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 关键护理医学 关键护理医学
背景情况:
- 右心室损伤 (RVI) 是呼吸衰竭患者的重要并发症,需要静脉静脉外体膜氧化 (VV ECMO).
- 在这种患者群体中,RVI与死亡率的增加有关.
- 目前的文献缺乏关于VV ECMO期间RVI的定义和管理的明确共识.
研究的目的:
- 对接受VV ECMO的患者的RVI现有文献进行范围审查.
- 在此背景下,对RVI的当前定义和管理策略进行映射.
- 识别知识差距并指导未来的研究方向.
主要方法:
- 在Medline,EMBASE和Web of Science进行了全面的文献搜索,对接受VV ECMO的患者的RVI进行了研究.
- 选了1868个引用,并包括了30项报告RVI的研究.
- 提取和分析了关于RVI定义和管理策略的数据.
主要成果:
- 23项研究提供了RVI的定义,主要使用右心室功能和尺寸的回声心脏指数.
- 13项研究报告了各种管理策略,包括不同的ECMO配置 (VP-ECMO,VA-ECMO),药理学剂,通风策略 (Ultra-LPV) 和PEEP优化.
- 在包括的研究中,在RVI的定义中观察到显著的异质性.
结论:
- 在VV ECMO患者中,RVI的定义是不一致的,这阻碍了跨研究的准确诊断和比较.
- 尽管在VV ECMO期间与RVI相关的发病率和死亡率很高,但对特定治疗干预措施的研究很少.
- 迫切需要就RVI的定义达成共识,并专门研究针对RV的治疗方法,以改善VVECMO患者的治疗结果.
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