From the UOS Advanced Respiratory Intensive Care Unit, UOC Anestesia e Rianimazione I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Anesthesia and Intensive Care, University of Pavia, Pavia, Italy.
ASAIO J. 2021 Jun 1;67(6):700-708. doi: 10.1097/MAT.0000000000001282.
Veno-venous extracorporeal membrane oxygenation (V-V ECMO) represents a component of the treatment strategy for severe respiratory failure. Clinical evidence on the management of the lung during V-V ECMO are limited just as the consensus regarding timing of weaning. The monitoring of the carbon dioxide (CO2) removal (V'CO2TOT) is subdivided into two components: the membrane lung (ML) and the native lung (NL) are both taken into consideration to evaluate the improvement of the function of the lung and to predict the time to wean off ECMO. We enrolled patients with acute respiratory distress syndrome (ARDS). The V'CO2NL ratio (V'CO2NL/V'CO2TOT) value was calculated based on the distribution of CO2 between the NL and the ML. Of 18 patients, 15 were successfully weaned off of V-V ECMO. In this subgroup, we observed a significant increase in the V'CO2NL ratio comparing the median values of the first and last quartiles (0.32 vs. 0.53, p = 0.0045), without observing any modifications in the ventilation parameters. An increase in the V'CO2NL ratio, independently from any change in ventilation could, despite the limitations of the study, indicate an improvement in pulmonary function and may be used as a weaning index for ECMO.
静脉-静脉体外膜肺氧合（V-V ECMO）是治疗严重呼吸衰竭的治疗策略的一部分。在 V-V ECMO 期间管理肺部的临床证据有限，正如关于脱机时机的共识一样。二氧化碳（CO2）清除（V'CO2TOT）的监测分为两个组成部分：膜肺（ML）和原生肺（NL）都被考虑在内，以评估肺功能的改善，并预测 ECMO 脱机的时间。我们招募了急性呼吸窘迫综合征（ARDS）患者。基于 NL 和 ML 之间 CO2 的分布，计算了 V'CO2NL 比值（V'CO2NL/V'CO2TOT）值。在 18 名患者中，有 15 名成功地从 V-V ECMO 脱机。在这个亚组中，我们观察到第一个四分位数和最后一个四分位数的 V'CO2NL 比值中位数显著增加（0.32 与 0.53，p=0.0045），而通气参数没有任何变化。尽管研究存在局限性，但 V'CO2NL 比值的增加，独立于通气的任何变化，可能表明肺功能的改善，并可用作 ECMO 的脱机指标。
