体外膜肺氧合治疗严重急性呼吸窘迫综合征的肺可复张性。

Lung Recruitability in Severe Acute Respiratory Distress Syndrome Requiring Extracorporeal Membrane Oxygenation.

机构信息

Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK.

Division of Centre of Human Applied Physiological Sciences, King's College London, London, UK.

出版信息

Crit Care Med. 2019 Sep;47(9):1177-1183. doi: 10.1097/CCM.0000000000003837.

DOI:10.1097/CCM.0000000000003837

PMID:31419216

Abstract

OBJECTIVES

Quantification of potential for lung recruitment may guide the ventilatory strategy in acute respiratory distress syndrome. However, there are no quantitative data on recruitability in patients with severe acute respiratory distress syndrome who require extracorporeal membrane oxygenation. We sought to quantify potential for lung recruitment and its relationship with outcomes in this cohort of patients.

DESIGN

A single-center, retrospective, observational cohort study.

SETTING

Tertiary referral severe respiratory failure center in a university hospital in the United Kingdom.

PATIENTS

Forty-seven adults with severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation.

INTERVENTION

None.

MEASUREMENTS AND MAIN RESULTS

In patients with severe acute respiratory distress syndrome-mainly of pulmonary origin (86%)-the potential for lung recruitment and the weight of nonaerated, poorly aerated, normally aerated, and hyperaerated lung tissue were assessed at low (5 cmH2O) and high (45 cmH2O) airway pressures. Patients were categorized as high or low potential for lung recruitment based on the median potential for lung recruitment value of the study population. The median potential for lung recruitment was 24.3% (interquartile range = 11.4-37%) ranging from -2% to 76.3% of the total lung weight. Patients with potential for lung recruitment above the median had significantly shorter extracorporeal membrane oxygenation duration (8 vs 13 d; p = 0.013) and shorter ICU stay (15 vs 22 d; p = 0.028), but mortality was not statistically different (24% vs 46%; p = 0.159).

CONCLUSIONS

We observed significant variability in potential for lung recruitment in patients with severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. Patients with high potential for lung recruitment had a shorter ICU stay and shorter extracorporeal membrane oxygenation duration.

摘要

目的

肺复张潜力的量化评估可能指导急性呼吸窘迫综合征患者的通气策略。然而，在需要体外膜肺氧合的严重急性呼吸窘迫综合征患者中，尚无关于可复张性的定量数据。本研究旨在评估该患者群体的肺复张潜力及其与结局的相关性。

设计

单中心、回顾性、观察性队列研究。

地点

英国一家大学附属医院的三级转诊严重呼吸衰竭中心。

患者

47 例需要体外膜肺氧合的严重急性呼吸窘迫综合征成人患者。

干预

无。

测量和主要结果

在主要由肺部原因引起的严重急性呼吸窘迫综合征患者（86%）中，在低（5 cmH2O）和高（45 cmH2O）气道压力下评估了肺复张潜力和未充气、充气不足、正常充气和过度充气肺组织的重量。根据研究人群的中位肺复张潜力值，将患者分为高或低肺复张潜力。中位肺复张潜力为 24.3%（四分位间距=11.4%-37%），范围从总肺重量的-2%到 76.3%。肺复张潜力高于中位数的患者，体外膜肺氧合时间（8 天 vs 13 天；p=0.013）和 ICU 住院时间（15 天 vs 22 天；p=0.028）显著缩短，但死亡率无统计学差异（24% vs 46%；p=0.159）。