Department Nephrology and Hypertension, Medical School Hannover, Germany.
BMC Nephrol. 2011 Apr 13;12:15. doi: 10.1186/1471-2369-12-15.
Extracorporeal lung assist devices are increasingly used in the intensive care unit setting to improve extracorporeal gas exchange mainly in patients with acute respiratory distress syndrome. ARDS is frequently accompanied by acute kidney injury; however it is so far unknown how the combination of these two conditions affects long term survival of critically ill patients.
In a retrospective analysis of a tertiary care hospital we evaluated all patients undergoing interventional lung assist (iLA) treatment between January 1st 2005 and December 31st 2009. Data from all 61 patients (31 F/30 M), median age 40 (28 to 52) years were obtained by chart review. Follow up data up to one year were obtained.
Of the 61 patients undergoing iLA membrane ventilator treatment 21 patients had acute kidney injury network (AKIN) stage 3 and were treated by extended dialysis (ED). Twenty-eight day survival of all patients was 33%. While patients without ED showed a 28 day survival of 40%, the survival of patients with ED was only 19%. Patients on ED were not different in respect to age, weight, Horowitz index and underlying disease.
AKI requiring ED therapy in patients undergoing iLA treatment increases mortality in ICU patients. Patients in whom iLA was placed as a bridge to lung transplantation and that were successfully transplanted showed the best outcome. Future studies have to clarify whether it is possible to identify patients that truly benefit from the combination of these two extracorporeal treatment methods.
体外肺辅助设备越来越多地用于重症监护病房，主要是为了改善急性呼吸窘迫综合征患者的体外气体交换。急性呼吸窘迫综合征常伴有急性肾损伤；然而，目前尚不清楚这两种情况的结合如何影响重症患者的长期生存。
我们对一家三级护理医院进行回顾性分析，评估了 2005 年 1 月 1 日至 2009 年 12 月 31 日期间接受介入性肺辅助（iLA）治疗的所有患者。通过病历回顾获得了所有 61 例患者（31 例女性/30 例男性）的数据，中位年龄为 40 岁（28 至 52 岁）。获得了长达一年的随访数据。
在接受 iLA 膜通气治疗的 61 例患者中，有 21 例患者急性肾损伤网络（AKIN）分期 3 期，并接受了延长透析（ED）治疗。所有患者的 28 天存活率为 33%。虽然未接受 ED 治疗的患者 28 天存活率为 40%，但接受 ED 治疗的患者存活率仅为 19%。接受 ED 治疗的患者在年龄、体重、霍罗威茨指数和基础疾病方面没有差异。
接受 iLA 治疗的患者需要 ED 治疗的 AKI 会增加 ICU 患者的死亡率。接受 iLA 治疗并成功进行肺移植的患者的预后最佳。未来的研究需要阐明是否有可能识别出真正受益于这两种体外治疗方法结合的患者。
