接受吸入一氧化氮治疗的先天性膈疝新生儿体外膜肺氧合支持需求的风险

Risk of need for extracorporeal membrane oxygenation support in neonates with congenital diaphragmatic hernia treated with inhaled nitric oxide.

作者信息

Sebald Matthew, Friedlich Philippe, Burns Cartland, Stein James, Noori Shahab, Ramanathan Rangasamy, Seri Istvan

机构信息

USC Division of Neonatal Medicine, Childrens Hospital Los Angeles and the Women's and Children's Hospital, LAC+USC Medical Center, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA.

出版信息

J Perinatol. 2004 Mar;24(3):143-6. doi: 10.1038/sj.jp.7211033.

DOI:10.1038/sj.jp.7211033

PMID:14961042

Abstract

BACKGROUND

Congenital diaphragmatic hernia (CDH) is often associated with severe pulmonary hypoplasia resulting in hypoxemic respiratory failure unresponsive to advanced medical management including the use of inhaled nitric oxide (iNO). For these patients, extracorporeal membrane oxygenation (ECMO) serves as the last potentially effective treatment choice. Since the efficacy of iNO in this patient population is not known and since most neonatal intensive care units using iNO for the treatment of these critically ill neonates do not provide ECMO, the ability to more accurately predict which patient is at risk for failing medical management with iNO and requires a timely transfer to an ECMO center can be life saving. Therefore, in this study, we sought to determine the risk factors for the need for ECMO in a cohort of 27 neonates with isolated left CDH and hypoxemic respiratory failure treated with iNO.

STUDY DESIGN

In this retrospective study, 27 patients with left CDH were identified during a 2-year period. During the study period, strict clinical guidelines had been used to standardize iNO therapy, to provide adequate lung inflation and cardiovascular support, and to recognize treatment failures and the need for ECMO. Logistic regression analysis was used to study the relationship between the need for ECMO and a set of suspected risk factors.

RESULTS

When subjected to logistic regression analysis, only the presence of a pneumothorax remained significantly associated with the need for ECMO (OR=22; 95% CI=2.18 to 222), while none of the other variables examined such as mean airway pressure, FiO2, PaO2, or PaCO2 were predictors for the need of ECMO after 6 hours of treatment with iNO.

CONCLUSION

These data indicate that a prompt transfer to an ECMO center should be initiated for hypoxemic patients with CDH receiving medical management with iNO if they develop an air leak syndrome.

摘要

背景

先天性膈疝（CDH）常伴有严重的肺发育不全，导致低氧性呼吸衰竭，对包括吸入一氧化氮（iNO）在内的先进医疗管理无反应。对于这些患者，体外膜肺氧合（ECMO）是最后的潜在有效治疗选择。由于iNO在该患者群体中的疗效尚不清楚，且大多数使用iNO治疗这些重症新生儿的新生儿重症监护病房不提供ECMO，因此更准确地预测哪些患者有iNO治疗失败的风险并需要及时转至ECMO中心的能力可能会挽救生命。因此，在本研究中，我们试图确定27例接受iNO治疗的孤立性左CDH和低氧性呼吸衰竭新生儿队列中需要ECMO的危险因素。