Belliato Mirko, Epis Francesco, Cremascoli Luca, Ferrari Fiorenza, Quattrone Maria Giovanna, Fisser Christoph, Malfertheiner Maximilian Valentin, Taccone Fabio Silvio, Di Nardo Matteo, Broman Lars Mikael, Lorusso Roberto
2nd Intensive Care Unit, UOC Anestesia e Rianimazione II Cardiopolmonare, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia, 27100 Pavia, Italy.
Membranes (Basel). 2021 Jan 2;11(1):30. doi: 10.3390/membranes11010030.
Mechanical power (MP) represents a useful parameter to describe and quantify the forces applied to the lungs during mechanical ventilation (MV). In this multi-center, prospective, observational study, we analyzed MP variations following MV adjustments after veno-venous extra-corporeal membrane oxygenation (VV ECMO) initiation. We also investigated whether the MV parameters (including MP) in the early phases of VV ECMO run may be related to the intensive care unit (ICU) mortality. Thirty-five patients with severe acute respiratory distress syndrome were prospectively enrolled and analyzed. After VV ECMO initiation, we observed a significant decrease in median MP (32.4 vs. 8.2 J/min, < 0.001), plateau pressure (27 vs. 21 cmHO, = 0.012), driving pressure (11 vs. 8 cmHO, = 0.014), respiratory rate (RR, 22 vs. 14 breaths/min, < 0.001), and tidal volume adjusted to patient ideal body weight (V/IBW, 5.5 vs. 4.0 mL/kg, = 0.001) values. During the early phase of ECMO run, RR (17 vs. 13 breaths/min, = 0.003) was significantly higher, while positive end-expiratory pressure (10 vs. 14 cmHO, = 0.048) and V/IBW (3.0 vs. 4.0 mL/kg, = 0.028) were lower in ICU non-survivors, when compared to the survivors. The observed decrease in MP after ECMO initiation did not influence ICU outcome. Waiting for large studies assessing the role of these parameters in VV ECMO patients, RR and MP monitoring should not be underrated during ECMO.
机械功率（MP）是描述和量化机械通气（MV）期间施加于肺部的力的一个有用参数。在这项多中心、前瞻性观察研究中，我们分析了静脉-静脉体外膜肺氧合（VV ECMO）启动后MV调整后的MP变化。我们还研究了VV ECMO运行早期阶段的MV参数（包括MP）是否可能与重症监护病房（ICU）死亡率相关。35例严重急性呼吸窘迫综合征患者被前瞻性纳入并进行分析。VV ECMO启动后，我们观察到MP中位数显著下降（32.4对8.2 J/分钟，<0.001）、平台压（27对21 cmH₂O，=0.012）、驱动压（11对8 cmH₂O，=0.014）、呼吸频率（RR，22对14次/分钟，<0.001）以及根据患者理想体重调整的潮气量（V/IBW，5.5对4.0 mL/kg，=0.001）值。在ECMO运行的早期阶段，与幸存者相比，ICU非幸存者的RR（17对13次/分钟，=0.003）显著更高，而呼气末正压（10对14 cmH₂O，=0.048）和V/IBW（3.0对4.0 mL/kg，=0.028）更低。ECMO启动后观察到的MP下降并未影响ICU结局。在等待评估这些参数在VV ECMO患者中作用的大型研究期间，在ECMO期间RR和MP监测不应被低估。
