Ramanathan Kollengode, Tan Chuen Seng, Rycus Peter, MacLaren Graeme
1Cardiothoracic Intensive Care Unit, National University Heart Center, Singapore. 2Swee Saw Hock School of Public Health, National University of Singapore, Singapore. 3Extracorporeal Life Support Organisation, Ann Arbor, MI.
Crit Care Med. 2017 May;45(5):814-821. doi: 10.1097/CCM.0000000000002320.
Extracorporeal membrane oxygenation is a rescue therapy used to support severe cardiorespiratory failure. Data on outcomes from severe community-acquired pneumonia in adults receiving rescue extracorporeal membrane oxygenation are mainly confined to single-center experiences or specific pathogens. We examined data from the Extracorporeal Life Support Organisation registry to identify risk factors for poor outcomes in adult patients with community-acquired pneumonia.
Retrospective data analysis.
Extracorporeal Life Support Organization Registry database.
We collected deidentified data on adult patients (> 18 yr) receiving extracorporeal membrane oxygenation for community-acquired pneumonia between 2002 and 2012. Patients with incomplete data or brain death were excluded. The primary outcome measure was in-hospital mortality. Other measurements included demographic information, pre-extracorporeal membrane oxygenation mechanical ventilation and biochemical variables, inotrope requirements, extracorporeal membrane oxygenation mode, duration, and complications. Initial univariate analysis assessed potential associations between survival and various pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation factors. Variables with p values of less than 0.1 were considered for logistic regression analysis to identify predictors of mortality.
None.
One thousand fifty-five patients, who satisfied inclusion criteria, were included in the final analysis. There was an increase in the number of patients cannulated per annum over the 10-year period studied. Univariate analysis identified pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation variables associated with high mortality. Further multiple regression analysis identified certain pre-extracorporeal membrane oxygenation factors as predictors of mortality, including duration of mechanical ventilation prior to extracorporeal membrane oxygenation, lower arterial pressure, fungal pneumonia, and advancing age. Type and duration of extracorporeal membrane oxygenation, neurologic complications, and presence of more than three complications on extracorporeal membrane oxygenation were also associated with higher mortality.
The majority (66%) of adults with community-acquired pneumonia supported on extracorporeal membrane oxygenation survived. Certain potentially modifiable risk factors were associated with increased mortality.
体外膜肺氧合是用于支持严重心肺功能衰竭的一种挽救治疗方法。关于接受挽救性体外膜肺氧合的成年社区获得性肺炎患者的预后数据主要局限于单中心经验或特定病原体。我们研究了体外生命支持组织登记处的数据，以确定成年社区获得性肺炎患者预后不良的危险因素。
回顾性数据分析。
体外生命支持组织登记数据库。
我们收集了2002年至2012年间因社区获得性肺炎接受体外膜肺氧合的成年患者（>18岁）的匿名数据。数据不完整或脑死亡的患者被排除。主要结局指标是住院死亡率。其他测量指标包括人口统计学信息、体外膜肺氧合前的机械通气和生化变量、血管活性药物需求、体外膜肺氧合模式、持续时间和并发症。初始单因素分析评估了生存与各种体外膜肺氧合前及体外膜肺氧合因素之间的潜在关联。p值小于0.1的变量被纳入逻辑回归分析以确定死亡率的预测因素。
无。
1055名符合纳入标准的患者纳入最终分析。在研究的10年期间，每年接受插管的患者数量有所增加。单因素分析确定了与高死亡率相关的体外膜肺氧合前及体外膜肺氧合变量。进一步的多因素回归分析确定了某些体外膜肺氧合前因素作为死亡率的预测因素，包括体外膜肺氧合前机械通气的持续时间、较低的动脉压、真菌性肺炎和年龄增长。体外膜肺氧合的类型和持续时间、神经系统并发症以及体外膜肺氧合时出现三种以上并发症也与较高的死亡率相关。
接受体外膜肺氧合支持的成年社区获得性肺炎患者大多数（66%）存活。某些潜在可改变的危险因素与死亡率增加相关。
