Department of Intensive Care Medicine, Frankston Hospital, Frankston, Victoria, Australia.
J Crit Care. 2012 Apr;27(2):192-8. doi: 10.1016/j.jcrc.2011.04.003. Epub 2011 Jun 23.
The mortality and morbidity of patients with severe acute respiratory distress syndrome (ARDS) remains high despite the advances in intensive care practice. The low-tidal-volume ventilation strategy (ARDS net protocol) has been shown to be effective in improving survival. Unfortunately, however, some patients have such severe ARDS that they cannot be managed with the ARDS net strategy. In these patients, rescue therapies such as high-frequency ventilation, prone ventilation, nitric oxide, and extracorporeal membrane oxygenation (ECMO) are considered. The CESAR trial has shown that an ECMO-based protocol improved survival without severe disability as compared with conventional ventilation. The recent increased incidence of severe respiratory failure due to H1N1 influenza pandemic has led to an increased use of ECMO. Although several reports showed ECMO use to be encouraging, some scepticism remains. In this article, we reviewed the usefulness of ECMO in patients with severe ARDS in the light of current evidence.
尽管重症加强护理病房的治疗水平已经取得了进步，但是严重急性呼吸窘迫综合征（ARDS）患者的死亡率和发病率仍然居高不下。低潮气量通气策略（ARDS 网络方案）已被证明可以有效提高生存率。然而，不幸的是，有些患者的 ARDS 非常严重，无法采用 ARDS 网络方案进行治疗。在这些患者中，高频通气、俯卧位通气、一氧化氮和体外膜肺氧合（ECMO）等抢救治疗方法被认为是有效的。CESAR 试验表明，与常规通气相比，基于 ECMO 的方案可以提高生存率，而不会导致严重残疾。最近由于 H1N1 流感大流行导致严重呼吸衰竭的发病率增加，导致 ECMO 的使用也有所增加。尽管有几项报告表明 ECMO 的使用令人鼓舞，但仍存在一些质疑。在本文中，我们根据现有证据，综述了 ECMO 在严重 ARDS 患者中的作用。
