在严重急性呼吸窘迫综合征中，稳定的体外膜肺氧合期间动脉血氧分压与吸入氧浓度比值（PaO₂/FiO₂）恶化与恢复时间延长及死亡率增加相关。

PaO/FiO Deterioration During Stable Extracorporeal Membrane Oxygenation Associates With Protracted Recovery and Increased Mortality in Severe Acute Respiratory Distress Syndrome.

作者信息

Roncon-Albuquerque Roberto, Ferreira-Coimbra João, Vilares-Morgado Rodrigo, Figueiredo Paulo, Paiva José Artur

机构信息

Department of Emergency and Intensive Care Medicine, Centro Hospitalar S. João, Porto, Portugal; Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.

Department of Internal Medicine, Centro Hospitalar S. João, Porto, Portugal.

出版信息

Ann Thorac Surg. 2016 Dec;102(6):1878-1885. doi: 10.1016/j.athoracsur.2016.06.026. Epub 2016 Sep 1.

DOI:10.1016/j.athoracsur.2016.06.026

PMID:27592605

Abstract

BACKGROUND

During extracorporeal membrane oxygenation (ECMO), arterial oxygen partial pressure to fractional inspired oxygen (PaO/FiO; PF ratio reflects native and artificial lung blood oxygenation). In this study we analyzed PF ratio during ECMO support and its association with clinical outcome.

METHODS

This was a single-center observational study of adult patients (n = 81) undergoing veno-venous ECMO support for severe acute respiratory distress syndrome.

RESULTS

In 37 patients (46%) PF ratio decreased from ECMO-day 1 to ECMO-day 7 (PF ratio deterioration [PF-d]; -37 ± 6.1 mm Hg), whereas in 44 patients PF ratio improved (PF-i; 65 ± 10.8 mm Hg). PF-d group required prolonged ECMO (median 21 days [interquartile range (IQR)]:14-35 days] versus 13 days [IQR: 10-20 days]) and invasive mechanical ventilation (median 33 days [IQR: 24-52 days] versus 26 days [IQR: 22-34 days]), longer intensive care unit (median 44 days [IQR: 32-74 days] versus 30 days [IQR: 25-47 days]), and hospital (median 66 days [IQR: 39-95 days] versus 36 days [IQR: 28-54 days]) lengths of stay, with higher hospital mortality rates (48.7% versus 22.7%). ECMO oxygenation did not explain PF ratio variation that remained stable in PF-d and decreased in PF-i (198 ± 12.7 mL/min versus 171 ± 8.8 mL/min). Pre-ECMO PF ratio, neuromuscular blockade, and prone position, as well as ventilatory variables did not differ between groups. The PF-d group was older (49 ± 2.1 years versus 41 ± 1.8 years) and presented lower Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) scores (0.57 ± 0.63 versus 2.2 ± 0.52). With the use of logistic regression, PF ratio variation remained an independent predictor of hospital mortality after adjusting for age or RESP score.

CONCLUSIONS

In severe acute respiratory distress syndrome, PF ratio deterioration during stable ECMO associates with protracted recovery and increased mortality, not accounted for by patient baseline characteristics, acute respiratory distress syndrome severity, or pre-ECMO management.

摘要

背景

在体外膜肺氧合（ECMO）期间，动脉血氧分压与吸入氧分数之比（PaO₂/FiO₂；PF 比值反映天然肺和人工肺的血液氧合情况）。在本研究中，我们分析了 ECMO 支持期间的 PF 比值及其与临床结局的关联。

方法

这是一项针对因严重急性呼吸窘迫综合征接受静脉 - 静脉 ECMO 支持的成年患者（n = 81）的单中心观察性研究。

结果

37 例患者（46%）的 PF 比值从 ECMO 第 1 天到 ECMO 第 7 天下降（PF 比值恶化[PF - d]；-37 ± 6.1 mmHg），而 44 例患者的 PF 比值改善（PF - i；65 ± 10.8 mmHg）。PF - d 组需要更长时间的 ECMO（中位数 21 天[四分位间距（IQR）]：14 - 35 天，而对照组为 13 天[IQR：10 - 20 天]）和有创机械通气（中位数 33 天[IQR：24 - 52 天]，而对照组为 26 天[IQR：22 - 34 天]），重症监护病房住院时间更长（中位数 44 天[IQR：32 - 74 天]，而对照组为 30 天[IQR：25 - 47 天]），以及医院住院时间更长（中位数 66 天[IQR：39 - 95 天]，而对照组为 36 天[IQR：28 - 54 天]），且医院死亡率更高（48.7% 对 22.7%）。ECMO 氧合并不能解释 PF 比值的变化，其在 PF - d 组保持稳定，在 PF - i 组下降（198 ± 12.7 mL/min 对 171 ± 8.8 mL/min）。ECMO 前的 PF 比值、神经肌肉阻滞、俯卧位以及通气变量在两组之间无差异。PF - d 组患者年龄更大（49 ± 2.1 岁对 41 ± 1.8 岁），且呼吸体外膜肺氧合生存预测（RESP）评分更低（0.57 ± 0.63 对 2.2 ± 0.52）。使用逻辑回归分析，在调整年龄或 RESP 评分后，PF 比值变化仍然是医院死亡率的独立预测因素。