俯卧位通气在严重急性呼吸窘迫综合征合并体外膜肺氧合治疗中的应用。
Prone positioning in severe ARDS requiring extracorporeal membrane oxygenation.
机构信息
Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
出版信息
Crit Care. 2020 Jul 8;24(1):397. doi: 10.1186/s13054-020-03110-2.
BACKGROUND
Prone positioning (PP) has shown to improve survival in patients with severe acute respiratory distress syndrome (ARDS). To this point, it is unclear if PP is also beneficial for ARDS patients treated with veno-venous extracorporeal membrane oxygenation (VV ECMO) support.
METHODS
We report retrospective data of a single-centre registry of patients with severe ARDS requiring VV ECMO support between October 2010 and May 2018. Patients were allocated to the PP group if PP was performed during VV ECMO treatment or the supine positioning group. VV ECMO weaning success and hospital survival were analysed before and after propensity score matching.
RESULTS
A total of 158 patients could be analysed, and 38 patients (24.1%) received PP. There were no significant differences in VV ECMO weaning rate (47.4% vs. 46.7%, p = 0.94) and hospital survival (36.8% vs. 36.7%, p = 0.98) between the prone and supine groups, respectively. The analysis of 38 propensity score matched pairs also showed no difference in hospital survival (36.8% vs. 36.8%, p = 1.0) or VV ECMO weaning rate (47.4% vs. 44.7%, p = 0.82). Hospital survival was superior in the subgroup of patients treated with early PP (cutoff < 17 h via Youden's Index) as compared to late or no PP (81.8% vs. 33.3%, p = 0.02).
CONCLUSION
In this propensity score matched cohort of severe ARDS patients requiring VV ECMO support, prone positioning at any time was not associated with improved weaning or survival. However, early initiation of prone positioning was linked to a significant reduction of hospital mortality.
背景
俯卧位（PP）已被证明可提高严重急性呼吸窘迫综合征（ARDS）患者的生存率。到目前为止，尚不清楚 PP 是否对接受静脉-静脉体外膜肺氧合（VV ECMO）支持的 ARDS 患者也有益。
方法
我们报告了 2010 年 10 月至 2018 年 5 月期间在一家单中心接受 VV ECMO 支持的严重 ARDS 患者的回顾性登记数据。如果在 VV ECMO 治疗期间进行了 PP，则将患者分配到 PP 组，否则分配到仰卧位组。在进行倾向评分匹配之前和之后，分析了 VV ECMO 脱机成功率和住院生存率。
结果
共分析了 158 例患者，其中 38 例（24.1%）接受了 PP。俯卧位组和仰卧位组的 VV ECMO 脱机率（47.4% vs. 46.7%，p=0.94）和住院生存率（36.8% vs. 36.7%，p=0.98）均无显著差异。38 对倾向评分匹配的配对分析也显示，住院生存率（36.8% vs. 36.8%，p=1.0）或 VV ECMO 脱机率（47.4% vs. 44.7%，p=0.82）无差异。与晚期或无 PP 相比，通过 Youden 指数的截止值<17 小时，早期接受 PP（81.8% vs. 33.3%，p=0.02）的患者住院生存率更高。
结论
在接受 VV ECMO 支持的严重 ARDS 患者的这一倾向评分匹配队列中，任何时间的俯卧位均与改善脱机或生存率无关。然而，早期开始俯卧位与显著降低住院死亡率有关。
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