重症监护病房中的嗜铬细胞瘤危象：一项法国多中心队列研究，重点关注挽救性体外膜肺氧合。

Pheochromocytoma Crisis in the ICU: A French Multicenter Cohort Study With Emphasis on Rescue Extracorporeal Membrane Oxygenation.

作者信息

Sauneuf Bertrand, Chudeau Nicolas, Champigneulle Benoit, Bouffard Claire, Antona Marion, Pichon Nicolas, Marrache David, Sonneville Romain, Marchalot Antoine, Welsch Camille, Kimmoun Antoine, Bouchet Bruno, Messai Elmi, Ricome Sylvie, Grimaldi David, Chelly Jonathan, Hanouz Jean-Luc, Mercat Alain, Terzi Nicolas

机构信息

1Service de Réanimation Médicale Polyvalente, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, France.2Service de Réanimation Médicale, Centre Hospitalier Universitaire, Avenue de la Côte de Nacre, Caen, France.3Service de Réanimation Médicale et Médecine hyperbare, Centre Hospitalier Universitaire, Angers, France.4Service de Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.5Service d'Anesthésie Réanimation, Groupement des Hôpitaux de l'Institut Catholique de Lille, Lille, France.6Service de Réanimation Chirurgicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.7Service de Réanimation Médico-chirurgicale, Centre Hospitalier Universitaire Dupuytren, Limoges Cedex, France.8Département d'Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.9Service de Réanimation Médicale et infectieuse, Hôpital Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France.10Service de Réanimation Médicale, Centre Hospitalier Universitaire, Rouen, France.11Service de Réanimation Médico-chirurgicale, Centre Hospitalier de Longjumeau, Longjumeau, France.12Service de Réanimation Médicale, Hôpital Brabois, Centre Hospitalier Universitaire, Vandoeuvre les Nancy, France.13Service de Réanimation Polyvalente, Hôpital Félix-Guyon, Centre Hospitalier Universitaire, Saint-Denis, La Réunion, France.14Service de Réanimation Polyvalente, Centre Hospitalier de Cholet, Cholet Cedex, France.15Service de Réanimation Polyvalente, Centre Hospitalier Robert Ballanger, boulevard Robert Ballanger, Aulnay sous Bois, France.16Service de Réanimation Polyvalente, Centre Hospitalier Versailles, Le Chesnay, France.17Service de Médecine intensive, Centre Hospitalier Marc Jacquet, Melun cedex, France.18Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire, Caen, France.19Université de Caen Normandie, Esplanade de la Paix, Caen, France.20Service de Réanimation Médicale, CHU Grenoble Alpes, Grenoble, France.

出版信息

Crit Care Med. 2017 Jul;45(7):e657-e665. doi: 10.1097/CCM.0000000000002333.

DOI:10.1097/CCM.0000000000002333

PMID:28403121

Abstract

OBJECTIVES

To describe the characteristics, management, and outcome of patients admitted to ICUs for pheochromocytoma crisis.

DESIGN

A 16-year multicenter retrospective study.

SETTING

Fifteen university and nonuniversity ICUs in France.

PATIENTS

Patients admitted in ICU for pheochromocytoma crisis.

INTERVENTIONS

None.

MEASUREMENT AND MAIN RESULTS

We included 34 patients with a median age of 46 years (40-54 yr); 65% were males. At admission, the median Sequential Organ Failure Assessment score was 8 (4-12) and median Simplified Acute Physiology Score II 49.5 (27-70). The left ventricular ejection fraction was consistently decreased with a median value of 30% (15-40%). Mechanical ventilation was required in 23 patients, mainly because of congestive heart failure. Vasoactive drugs were used in 23 patients (68%) and renal replacement therapy in eight patients (24%). Extracorporeal membrane oxygenation was used as a rescue therapy in 14 patients (41%). Pheochromocytoma was diagnosed by CT in 33 of 34 patients. When assayed, urinary metanephrine and catecholamine levels were consistently elevated. Five patients underwent urgent surgery, including two during extracorporeal membrane oxygenation. Overall ICU mortality was 24% (8/34), and overall 90-day mortality was 27% (9/34). Crude 90-day mortality was not significantly different between patients managed with versus without extracorporeal membrane oxygenation (22% vs 30%) (p = 0.7) despite higher severity scores at admission in the extracorporeal membrane oxygenation group.

CONCLUSIONS

Mortality is high in pheochromocytoma crisis. Routinely considering this diagnosis and performing abdominal CT in patients with unexplained cardiogenic shock may allow an earlier diagnosis. Extracorporeal membrane oxygenation and adrenalectomy should be considered as a therapeutic in most severe cases.

摘要

目的

描述因嗜铬细胞瘤危象入住重症监护病房（ICU）患者的特征、治疗及结局。

设计

一项为期16年的多中心回顾性研究。

地点

法国15家大学及非大学附属医院的ICU。

患者

因嗜铬细胞瘤危象入住ICU的患者。

干预措施

无。

测量指标及主要结果

我们纳入了34例患者，中位年龄46岁（40 - 54岁）；65%为男性。入院时，序贯器官衰竭评估（Sequential Organ Failure Assessment）评分中位数为8（4 - 12），简化急性生理学评分II（Simplified Acute Physiology Score II）中位数为49.5（27 - 70）。左心室射血分数持续降低，中位数为30%（15 - 40%）。23例患者需要机械通气，主要原因是充血性心力衰竭。23例患者（68%）使用了血管活性药物，8例患者（24%）接受了肾脏替代治疗。14例患者（41%）采用体外膜肺氧合（extracorporeal membrane oxygenation）作为挽救治疗。34例患者中有33例通过CT诊断为嗜铬细胞瘤。检测时，尿间甲肾上腺素和儿茶酚胺水平持续升高。5例患者接受了急诊手术，其中2例在体外膜肺氧合期间进行。ICU总体死亡率为24%（8/34），90天总体死亡率为27%（9/34）。尽管体外膜肺氧合组入院时病情严重程度评分更高，但接受或未接受体外膜肺氧合治疗的患者90天粗死亡率无显著差异（22%对30%）（p = 0.7）。