Brunet Jennifer, Valette Xavier, Buklas Dimitrios, Lehoux Philippe, Verrier Pierre, Sauneuf Bertrand, Ivascau Calin, Dalibert Yves, Seguin Amélie, Terzi Nicolas, Babatasi Gérard, du Cheyron Damien, Parienti Jean-Jacques, Daubin Cédric
Department of Anesthesiology.
Department of Medical Intensive Care.
Respir Care. 2017 Jul;62(7):912-919. doi: 10.4187/respcare.05098. Epub 2017 May 23.
We aimed to test the performance of PRESERVE and RESP scores to predict death in patients with severe ARDS receiving extracorporeal membrane oxygenation (ECMO) with different case mixes.
All consecutive patients treated with ECMO for refractory ARDS, regardless of cause, in the Caen University Hospital in northwestern France over the last decade were included in a retrospective cohort study. The receiver operating characteristic curves of each score were plotted, and the area under the curve was computed to assess their performance in predicting mortality (c-index).
Forty-one subjects were included. Pre-ECMO ventilator settings were: mean V, 6.1 ± 0.9 mL/kg; breathing frequency, 32 ± 4 breaths/min; PEEP, 11 ± 4 cm HO; peak inspiratory pressure, 48 ± 9 cm HO; plateau pressure, 30.4 ± 4.4 cm HO. At ECMO initiation, blood gas results were: pH 7.22 ± 0.17, P /F = 63 ± 22 mm Hg; P = 56 ± 18 mm Hg; F = 99 ± 2%. Pre-ECMO data were available in 35 and 27 subjects for calculation of the PRESERVE score and RESP score, respectively. Pre-ECMO scoring system results were: median PRESERVE score, 4 (interquartile range 2-5), and median RESP score, 0 (interquartile range -2 to 2). Twenty-three subjects (56%) died, including 19 receiving ECMO. In univariate analysis, plateau pressure ( = .031), driving pressure ( = <.001), and compliance ( = .02) recorded at the time of ECMO initiation as well as the PRESERVE score ( = .032) were significantly associated with mortality. With a c-index of 0.69 (95% CI 0.53-0.87), the PRESERVE score had better discrimination than the RESP score (c-index of 0.60 [95% CI 0.41-0.78]) for predicting mortality.
The use of these scores in helping physicians to determine the patients with ARDS most likely to benefit from ECMO should be limited in clinical practice because of their relatively poor performance in predicting death in subjects with severe ARDS receiving ECMO support. Before widespread use is initiated, these scoring systems should be tested in large prospective studies of subjects with severe ARDS undergoing ECMO treatment.
我们旨在测试PRESERVE评分和RESP评分在预测接受体外膜肺氧合（ECMO）治疗的不同病例组合的重症急性呼吸窘迫综合征（ARDS）患者死亡情况方面的性能。
在法国西北部卡昂大学医院过去十年中，所有因难治性ARDS接受ECMO治疗的连续患者，无论病因如何，均纳入一项回顾性队列研究。绘制每个评分的受试者工作特征曲线，并计算曲线下面积以评估其预测死亡率的性能（c指数）。
纳入41名受试者。ECMO前的呼吸机设置为：平均潮气量，6.1±0.9 ml/kg；呼吸频率，32±4次/分钟；呼气末正压，11±4 cmH₂O；吸气峰压，48±9 cmH₂O；平台压，30.4±4.4 cmH₂O。在开始ECMO时，血气结果为：pH 7.22±0.17，P/F = 63±22 mmHg；PCO₂ = 56±18 mmHg；FiO₂ = 99±2%。分别有35名和27名受试者可获得ECMO前数据用于计算PRESERVE评分和RESP评分。ECMO前评分系统结果为：PRESERVE评分中位数为4（四分位间距2 - 5），RESP评分中位数为0（四分位间距 - 2至2）。23名受试者（56%）死亡，其中19名接受了ECMO治疗。在单因素分析中，ECMO开始时记录的平台压（P = 0.031）、驱动压（P = <0.001）和顺应性（P = 0.02）以及PRESERVE评分（P = 0.032）与死亡率显著相关。对于预测死亡率，PRESERVE评分的c指数为0.69（95%CI 0.53 - 0.87），其区分能力优于RESP评分（c指数为0.60 [95%CI 0.41 - 0.78]）。
在临床实践中，由于这些评分在预测接受ECMO支持的重症ARDS患者死亡方面表现相对较差，因此在帮助医生确定最有可能从ECMO中获益的ARDS患者时，其应用应受到限制。在广泛应用之前，这些评分系统应在接受ECMO治疗的重症ARDS患者的大型前瞻性研究中进行测试。
