Akkanti Bindu, Jagpal Sugeet, Darwish Ribal, Saavedra Romero Ramiro, Scott L Keith, Dinh Kha, Hussain Sabiha, Radbel Jared, Saad Mohamed A, Enfield Kyle B, Conrad Steven A
Division of Critical Care, Pulmonary and Sleep, Department of Medicine, University of Texas McGovern Medical School, Houston, TX.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ.
Crit Care Explor. 2021 Mar 9;3(3):e0372. doi: 10.1097/CCE.0000000000000372. eCollection 2021 Mar.
About 15% of hospitalized coronavirus disease 2019 patients require ICU admission, and most (80%) of these require invasive mechanical ventilation. Lung-protective ventilation in coronavirus disease 2019 acute respiratory failure may result in severe respiratory acidosis without significant hypoxemia. Low-flow extracorporeal Co removal can facilitate lung-protective ventilation and avoid the adverse effects of severe respiratory acidosis. The objective was to evaluate the efficacy of extracorporeal Co removal using the Hemolung Respiratory Assist System in correcting severe respiratory acidosis in mechanically ventilated coronavirus disease 2019 patients with severe acute respiratory failure.
Retrospective cohort analysis of patients with coronavirus disease 2019 mechanically ventilated with severe hypercapnia and respiratory acidosis and treated with low-flow extracorporeal Co removal.
Eight tertiary ICUs in the United States.
Adult patients supported with the Hemolung Respiratory Assist System from March 1, to September 30, 2020.
Extracorporeal Co removal with Hemolung Respiratory Assist System under a Food and Drug Administration emergency use authorization for coronavirus disease 2019.
The primary outcome was improvement in pH and Paco from baseline. Secondary outcomes included survival to decannulation, mortality, time on ventilator, and adverse events. Thirty-one patients were treated with Hemolung Respiratory Assist System with significant improvement in pH and Pco in this cohort. Two patients experienced complications that prevented treatment. Of the 29 treated patients, 58% survived to 48 hours post treatment and 38% to hospital discharge. No difference in age or comorbidities were noted between survivors and nonsurvivors. There was significant improvement in pH (7.24 ± 0.12 to 7.35 ± 0.07; < 0.0001) and Paco (79 ± 23 to 58 ± 14; < 0.0001) from baseline to 24 hours.
In this retrospective case series of 29 patients, we have demonstrated efficacy of extracorporeal Co removal using the Hemolung Respiratory Assist System to improve respiratory acidosis in patients with severe hypercapnic respiratory failure due to coronavirus disease 2019.
约15%的新型冠状病毒肺炎住院患者需要入住重症监护病房（ICU），其中大多数（80%）需要有创机械通气。新型冠状病毒肺炎急性呼吸衰竭患者采用肺保护性通气可能会导致严重呼吸性酸中毒而无明显低氧血症。低流量体外二氧化碳清除可促进肺保护性通气并避免严重呼吸性酸中毒的不良影响。目的是评估使用Hemolung呼吸辅助系统进行体外二氧化碳清除对纠正机械通气的新型冠状病毒肺炎严重急性呼吸衰竭患者严重呼吸性酸中毒的疗效。
对新型冠状病毒肺炎机械通气伴严重高碳酸血症和呼吸性酸中毒并接受低流量体外二氧化碳清除治疗的患者进行回顾性队列分析。
美国的8家三级ICU。
2020年3月1日至9月30日期间接受Hemolung呼吸辅助系统支持的成年患者。
在食品药品监督管理局针对新型冠状病毒肺炎的紧急使用授权下，使用Hemolung呼吸辅助系统进行体外二氧化碳清除。
主要结局是pH值和动脉血二氧化碳分压（Paco）较基线水平有所改善。次要结局包括脱管存活、死亡率、机械通气时间和不良事件。31例患者接受了Hemolung呼吸辅助系统治疗，该队列患者的pH值和二氧化碳分压（Pco）有显著改善。2例患者出现并发症，无法继续治疗。在29例接受治疗的患者中，58%存活至治疗后48小时，38%存活至出院。存活者和非存活者在年龄或合并症方面无差异。从基线到24小时，pH值（从7.24±0.12升至7.35±0.07；P<0.0001）和Paco（从79±23降至58±14；P<0.0001）有显著改善。
在这个包含29例患者的回顾性病例系列中，我们证明了使用Hemolung呼吸辅助系统进行体外二氧化碳清除可改善新型冠状病毒肺炎所致严重高碳酸血症呼吸衰竭患者的呼吸性酸中毒。
