General Intensive Care Unit, Emergency Department - San Gerardo Hospital, University of Milan-Bicocca, Via Pergolesi 33, Monza (MB), Italy; University of Milan-Bicocca, Milan, Italy.
Adult Intensive Care Unit, Glenfield Hospital, University Hospital of Leicester-NHS Trust, Groby Rd, Leicester LE3 9QP, United Kingdom.
Intensive Crit Care Nurs. 2018 Oct;48:61-68. doi: 10.1016/j.iccn.2018.04.002. Epub 2018 Jul 20.
Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) is an advanced respiratory care therapy allowing replacement of pulmonary gas exchange. Despite VV-ECMO support, some patients may remain hypoxaemic. A possible therapeutic procedure for these patients is the application of prone positioning.
The primary aim of the present study was to investigate modification of the PaO/FiO ratio, in VV-ECMO patients with refractory hypoxaemia. The secondary aim was to evaluate the safety and feasibility of prone positioning for patients with severe Adult Respiratory Distress Syndrome supported by ECMO.
We retrospectively reviewed the electronic records and charts of all patients supported by VV-ECMO who experienced at least one pronation. Complications related with prone positioning were also recorded. First PaO/FiO ratio was analysed during four different time steps: before pronation, one hour after pronation, at the end of pronation and one hour after returning to supine.
A total of 45 prone positioning manoeuvers were performed in 14 VV-ECMO patients from November 2009 to November 2014. The median duration of prone positioning cycles was 8 hours (IQR 6-10). No accidental dislodgement of intravascular lines, endotracheal tubes, chest tubes or a decrease in ECMO blood flow was observed. During the first prone positioning for each patient, the median PaO/FiO ratio recorded was 123 (IQR 82-135), 152 (93-185), 149 (90-186) and 113 (74-182), during PRE-supine step, 1 h-prone positioning step, END-prone positioning step, and POST-supine step respectively.
The application of prone positioning during VV-ECMO has shown to be a safe and reliable technique when performed in a recognised ECMO centre with the appropriately trained staff and standard procedures.
静脉-静脉体外膜肺氧合（VV-ECMO）是一种高级呼吸治疗技术，可替代肺气体交换。尽管有 VV-ECMO 支持，一些患者仍可能存在低氧血症。对于这些患者，一种可能的治疗方法是俯卧位。
本研究的主要目的是研究 VV-ECMO 患者难治性低氧血症时 PaO/FiO 比值的变化。次要目的是评估 ECMO 支持的严重成人呼吸窘迫综合征患者俯卧位的安全性和可行性。
我们回顾性分析了 2009 年 11 月至 2014 年 11 月期间接受 VV-ECMO 支持且至少接受一次俯卧位的所有患者的电子病历和图表。还记录了与俯卧位相关的并发症。分析了四个不同时间点的第一 PaO/FiO 比值：俯卧位前、俯卧位后 1 小时、俯卧位结束时和仰卧位后 1 小时。
2009 年 11 月至 2014 年 11 月期间，14 名 VV-ECMO 患者共进行了 45 次俯卧位。俯卧位周期的中位数为 8 小时（IQR 6-10）。未观察到血管内导管、气管内导管、胸腔引流管意外移位或 ECMO 血流量减少。对于每位患者的第一次俯卧位，记录的中位 PaO/FiO 比值分别为 PRE-supine 步 123（IQR 82-135）、1 小时俯卧位步 152（93-185）、END-prone 步 149（90-186）和 POST-supine 步 113（74-182）。
在具有适当培训人员和标准程序的认可 ECMO 中心进行时，VV-ECMO 期间应用俯卧位是一种安全可靠的技术。
