巴西一家三级医疗中心在使用体外膜肺氧合支持重症患者方面的首年经验。
First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation.
机构信息
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP, Brazil.
出版信息
Clinics (Sao Paulo). 2012 Oct;67(10):1157-63. doi: 10.6061/clinics/2012(10)07.
OBJECTIVES
The aim of this manuscript is to describe the first year of our experience using extracorporeal membrane oxygenation support.
METHODS
Ten patients with severe refractory hypoxemia, two with associated severe cardiovascular failure, were supported using venous-venous extracorporeal membrane oxygenation (eight patients) or veno-arterial extracorporeal membrane oxygenation (two patients).
RESULTS
The median age of the patients was 31 yr (range 14-71 yr). Their median simplified acute physiological score three (SAPS3) was 94 (range 84-118), and they had a median expected mortality of 95% (range 87-99%). Community-acquired pneumonia was the most common diagnosis (50%), followed by P. jiroveci pneumonia in two patients with AIDS (20%). Six patients were transferred from other ICUs during extracorporeal membrane oxygenation support, three of whom were transferred between ICUs within the hospital (30%), two by ambulance (20%) and one by helicopter (10%). Only one patient (10%) was anticoagulated with heparin throughout extracorporeal membrane oxygenation support. Eighty percent of patients required continuous venous-venous hemofiltration. Three patients (30%) developed persistent hypoxemia, which was corrected using higher positive end-expiratory pressure, higher inspired oxygen fractions, recruitment maneuvers, and nitric oxide. The median time on extracorporeal membrane oxygenation support was five (range 3-32) days. The median length of the hospital stay was 31 (range 3-97) days. Four patients (40%) survived to 60 days, and they were free from renal replacement therapy and oxygen support.
CONCLUSIONS
The use of extracorporeal membrane oxygenation support in severely ill patients is possible in the presence of a structured team. Efforts must be made to recognize the necessity of extracorporeal respiratory support at an early stage and to prompt activation of the extracorporeal membrane oxygenation team.
目的
本文旨在描述我们使用体外膜氧合支持的第一年的经验。
方法
10 例严重难治性低氧血症患者，其中 2 例合并严重心血管衰竭，采用静脉-静脉体外膜氧合（8 例）或静脉-动脉体外膜氧合（2 例）支持。
结果
患者的中位年龄为 31 岁（范围 14-71 岁）。他们的简化急性生理学评分三（SAPS3）中位数为 94（范围 84-118），预计死亡率中位数为 95%（范围 87-99%）。社区获得性肺炎是最常见的诊断（50%），其次是 AIDS 患者中的 2 例耶氏肺孢子菌肺炎（20%）。6 例患者在体外膜氧合支持期间从其他 ICU 转来，其中 3 例在院内 ICU 之间转科（30%），2 例通过救护车（20%），1 例通过直升机（10%）。只有 1 例（10%）患者在整个体外膜氧合支持过程中使用肝素抗凝。80%的患者需要持续静脉-静脉血液滤过。3 例（30%）患者出现持续性低氧血症，通过增加呼气末正压、增加吸入氧分数、复张手法和一氧化氮纠正。体外膜氧合支持中位时间为 5（范围 3-32）天。中位住院时间为 31（范围 3-97）天。4 例（40%）患者存活至 60 天，且无需肾脏替代治疗和氧支持。
结论
在有结构化团队的情况下，严重疾病患者使用体外膜氧合支持是可行的。必须努力在早期认识到体外呼吸支持的必要性，并及时启动体外膜氧合团队。
Zotero 插件