Brown J Kristine, Haft Jonathan W, Bartlett Robert H, Hirschl Ronald B
Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA.
Semin Respir Crit Care Med. 2006 Aug;27(4):416-25. doi: 10.1055/s-2006-948295.
Acute respiratory distress syndrome (ARDS) has many underlying causes and carries an overall mortality of 40 to 60%. For those patients with severe ARDS who have a predicted mortality of 80 to 100%, extracorporeal life support (ECLS) can provide an extraordinary means of support. We recently demonstrated a survival to hospital discharge of 52% in this subset of patients. ECLS is capable of providing full respiratory and cardiac support, allowing time for the patient to recover from the underlying disease process. Additionally, ventilator settings are reduced to "rest" settings, avoiding the consequences of ventilator-induced lung injury that can contribute to a worse outcome. Systemic heparinization is a mainstay of ECLS therapy because of platelet activation in the circuit. Mechanical complications and significant bleeding can occur in up to one quarter of patients, requiring close attention and prompt intervention should they occur. Although not currently in clinical practice, liquid ventilation using perfluorocarbons to provide gas exchange in the lungs is a potentially useful adjunct in the management of severe respiratory failure.
急性呼吸窘迫综合征（ARDS）有多种潜在病因，总体死亡率为40%至60%。对于那些预计死亡率为80%至100%的重度ARDS患者，体外生命支持（ECLS）可提供一种特殊的支持手段。我们最近证明，这一亚组患者的出院生存率为52%。ECLS能够提供全面的呼吸和心脏支持，使患者有时间从潜在疾病过程中恢复。此外，呼吸机设置可降至“休息”设置，避免呼吸机诱导性肺损伤导致更差结局。由于体外循环中血小板激活，全身肝素化是ECLS治疗的主要手段。高达四分之一的患者可能出现机械并发症和严重出血，一旦发生需要密切关注并及时干预。尽管目前尚未应用于临床实践，但使用全氟化碳在肺部进行气体交换的液体通气在严重呼吸衰竭的管理中可能是一种有用的辅助手段。
