Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY, USA.
Center for Acute Respiratory Failure, Columbia University Medical Center, New York, NY, USA.
Intensive Care Med. 2020 Feb;46(2):182-191. doi: 10.1007/s00134-019-05847-z. Epub 2019 Nov 25.
Extracorporeal life support (ECLS) is increasingly used in the management of patients with severe cardiopulmonary disease. Infections are frequently the etiologies underlying the respiratory, and occasionally cardiac, failure that necessitates ECLS. Just as importantly, infections are among the most commonly reported adverse events during ECLS. Infections in this setting may be the sequelae of prolonged critical illness or of underlying immune dysregulation; they may be hospital-acquired infections, and they may or may not be attributable to the presence of ECLS itself, the latter being an aspect that can be difficult to determine. Current registry data and evidence from the literature offer some insights, but also leave open many questions regarding the nature and significance of infections reported both before and during ECLS, including the question of any causal link between ECLS and the development of infections. An ongoing lack of consistency in the identification, diagnosis, management, and prevention of infections during ECLS is limiting our ability to interpret literature data and thus highlighting the need for more rigorous investigation and standardization of definitions. This review aims to characterize the current understanding of infections associated with the use of ECLS, taking into account data from the updated Extracorporeal Life Support Organization Registry, which provides important context for understanding the epidemiology and outcomes of these patients.
体外生命支持（ECLS）越来越多地用于治疗严重心肺疾病的患者。感染是导致需要 ECLS 的呼吸衰竭，偶尔也会导致心脏衰竭的常见病因。同样重要的是，感染是 ECLS 期间最常报告的不良事件之一。在这种情况下，感染可能是长期严重疾病或潜在免疫失调的后果；它们可能是医院获得性感染，也可能与 ECLS 本身的存在有关，也可能无关，后者很难确定。当前的登记数据和文献证据提供了一些见解，但也留下了许多关于 ECLS 前后报告的感染的性质和意义的问题，包括 ECLS 与感染发展之间是否存在因果关系的问题。在 ECLS 期间，感染的识别、诊断、管理和预防方面持续缺乏一致性，限制了我们解释文献数据的能力，因此强调需要更严格的调查和标准化定义。本综述旨在描述与使用 ECLS 相关的感染的现有认识，同时考虑到体外生命支持组织登记处更新的数据，该数据为了解这些患者的流行病学和结局提供了重要背景。
