Spinelli Elena, Mauri Tommaso, Carlesso Eleonora, Crotti Stefania, Tubiolo Daniela, Lissoni Alfredo, Bottino Nicola, Panigada Mauro, Tagliabue Paola, Rossi Nicola, Scotti Eleonora, Conigliaro Federica, Gattinoni Luciano, Grasselli Giacomo, Pesenti Antonio
From the Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Pathophysiology and Transplantation, University of Milan, Italy.
ASAIO J. 2020 Jun;66(6):663-670. doi: 10.1097/MAT.0000000000001048.
In patients undergoing extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS), it is unknown which clinical physiologic variables should be monitored to follow the evolution of lung injury and extrapulmonary organ dysfunction and to differentiate patients according to their course. We analyzed the time-course of prospectively collected clinical physiologic variables in 83 consecutive ARDS patients undergoing ECMO at a single referral center. Selected variables-including ventilator settings, respiratory system compliance, intrapulmonary shunt, arterial blood gases, central hemodynamics, and sequential organ failure assessment (SOFA) score-were compared according to outcome at time-points corresponding to 0%, 25%, 50%, 75%, and 100% of the entire ECMO duration and daily during the first 7 days. A logistic regression analysis was performed to identify changes between ECMO start and end that independently predicted hospital mortality. Tidal volume, intrapulmonary shunt, arterial lactate, and SOFA score differentiated survivors and nonsurvivors early during the first 7 days and over the entire ECMO duration. Respiratory system compliance, PaO2/FiO2 ratio, arterial pH, and mean pulmonary arterial pressure showed distinct temporal course according to outcome over the entire ECMO duration. Lack of improvement of SOFA score independently predicted hospital mortality. In ARDS patients on ECMO, temporal trends of specific physiologic parameters differentiate survivors from non-survivors and could be used to monitor the evolution of lung injury. Progressive worsening of extrapulmonary organ dysfunction is associated with worse outcome.
在因急性呼吸窘迫综合征（ARDS）接受体外膜肺氧合（ECMO）治疗的患者中，尚不清楚应监测哪些临床生理变量来跟踪肺损伤和肺外器官功能障碍的演变，并根据患者的病程进行区分。我们分析了在一家单一转诊中心连续83例接受ECMO治疗的ARDS患者前瞻性收集的临床生理变量的时间进程。根据在整个ECMO持续时间的0%、25%、50%、75%和100%以及前7天每天对应的时间点的结果，比较了选定的变量，包括呼吸机设置、呼吸系统顺应性、肺内分流、动脉血气、中心血流动力学和序贯器官衰竭评估（SOFA）评分。进行逻辑回归分析以确定ECMO开始和结束之间独立预测医院死亡率的变化。潮气量、肺内分流、动脉乳酸和SOFA评分在最初7天内及整个ECMO持续期间早期可区分存活者和非存活者。呼吸系统顺应性、PaO2/FiO2比值、动脉pH值和平均肺动脉压在整个ECMO持续期间根据结果显示出明显不同的时间进程。SOFA评分缺乏改善独立预测医院死亡率。在接受ECMO治疗的ARDS患者中，特定生理参数的时间趋势可区分存活者和非存活者，并可用于监测肺损伤的演变。肺外器官功能障碍的进行性恶化与更差的预后相关。
