Department of Pediatrics, Division of Pediatric Critical Care, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA.
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.
Int J Artif Organs. 2022 Feb;45(2):174-180. doi: 10.1177/0391398821999386. Epub 2021 Mar 15.
We aimed to use the Extracorporeal Life Support Organization registry to describe the current practice of rest mechanical ventilation setting in children receiving veno-venous extracorporeal membrane oxygenation (V-V ECMO) and to determine if relationships exist between ventilator settings and mortality.
Data for patients 14 days to 18 years old who received V-V ECMO from 2012-2016 were reviewed. Mechanical ventilation data available includes mode and settings at 24 h after ECMO cannulation. Multivariable logistic regression analysis was performed to determine if rest settings were associated with mortality.
We reviewed 1161 subjects, of which 1022 (88%) received conventional mechanical ventilation on ECMO. Rest settings, expressed as medians (25th%, 75th%), are as follows: rate 12 breaths/minute (10, 17); peak inspiratory pressure (PIP) 22 cmHO (20,27); positive end expiratory pressure (PEEP) 10 cmHO (8, 10); and fraction of inspired oxygen (FO) 0.4 (0.37, 0.60). Survival to discharge was 68%. Higher ventilator FO (odds ratio:1.13 per 0.1 increase, 95% confidence interval:1.04, 1.23), independent of arterial oxygen saturation, was associated with mortality.
Current rest ventilator management for children receiving V-V ECMO primarily relies on conventional mechanical ventilation with moderate amounts of PIP, PEEP, and FiO. Further study on the relationship between FiO and mortality should be pursued.
我们旨在利用体外生命支持组织登记处描述目前接受静脉-静脉体外膜肺氧合（V-V ECMO）的儿童机械通气设置的情况，并确定通气设置与死亡率之间是否存在关系。
回顾了 2012-2016 年期间接受 V-V ECMO 的 14 天至 18 岁的患者数据。可获得机械通气数据，包括 ECMO 置管后 24 小时的通气模式和设置。采用多变量逻辑回归分析来确定休息设置是否与死亡率相关。
我们回顾了 1161 例患者，其中 1022 例（88%）在 ECMO 上接受了常规机械通气。休息设置以中位数（25%，75%）表示如下：频率 12 次/分钟（10，17）；吸气峰压（PIP）22cmH2O（20，27）；呼气末正压（PEEP）10cmH2O（8，10）；吸入氧分数（FiO）0.4（0.37，0.60）。出院时的存活率为 68%。较高的呼吸机 FiO（比值比：每增加 0.1 个单位增加 1.13，95%置信区间：1.04，1.23），独立于动脉血氧饱和度，与死亡率相关。
目前接受 V-V ECMO 的儿童休息时的呼吸机管理主要依赖于具有中等 PIP、PEEP 和 FiO 的常规机械通气。应进一步研究 FiO 与死亡率之间的关系。
