Lyu Guangyu, Cai Tianbin, Jiang Wenfang, Liu Meiqiong, Wang Xiaoyuan
Department of Critical Care Medicine, Liuzhou People's Hospital, Liuzhou 545006, Guangxi Zhuang Autonomous Region, China. Corresponding author: Wang Xiaoyuan, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Mar;33(3):293-298. doi: 10.3760/cma.j.cn121430-20200805-00563.
To observe the effects of veno-venous extracorporeal membrane oxygenation (VV-ECMO) combined with prone position ventilation (PPV) on oxygenation index (PaO/FiO), respiratory compliance (Crs) and vasoactive inotropic score (VIS) in severe acute respiratory distress syndrome (ARDS) patients.
Eighteen patients with severe ARDS requiring VV-ECMO support in Liuzhou People's Hospital from June 2018 to April 2020 were selected for retrospective analysis, and 8 patients among of these cases received PPV after VV-ECMO. The differences in PaO/FiO, VIS and Crs before and 1, 2 or 3 days after treatment were compared between VV-ECMO group and VV-ECMO combined with PPV group, as well as the differences in these indices before PPV and 2 hours after PPV daily in VV-ECMO combined with PPV group. The incidence of adverse events in two groups were also observed.
Before treatment, there was no significant difference in PaO/FiO, Crs between two groups. Over time, PaO/FiO and Crs increased and VIS decreased in both groups. Compared with before treatment, there were statistically significant differences in PaO/FiO and VIS from 1 day after treatment [PaO/FiO (mmHg, 1 mmHg = 0.133 kPa): VV-ECMO group was 197.75±39.80 vs. 75.57±7.44, VV-ECMO combined with PPV group was 255.20±31.92 vs. 68.24±11.64; VIS: VV-ECMO group was 5.51±3.72 vs. 10.20±7.10, VV-ECMO combined with PPV group was 6.73±3.32 vs. 14.50±2.48, all P < 0.05], up to 3 days after treatment [PaO/FiO (mmHg): VV-ECMO group was 231.96±32.76 vs. 75.57±7.44, VV-ECMO combined with PPV group was 285.61±19.40 vs. 68.24±11.64; VIS: VV-ECMO group was 2.26±1.90 vs. 10.20±7.10, VV-ECMO combined with PPV group was 2.13±1.55 vs. 14.50±2.48, all P < 0.05], and the PaO/FiO 1 day and 3 days after treatment in VV-ECMO combined with PPV group were significantly higher than those in VV-ECMO group (mmHg: after 1 day of treatment was 255.20±31.92 vs. 197.75±39.80, after 3 days of treatment was 285.61±19.40 vs. 231.96±32.76, both P < 0.05). Before treatment, Crs of VV-ECMO combined with PPV group was significantly lower than that of VV-ECMO group (mL/cmHO: 17.91±0.82 vs. 20.54±1.26, P < 0.05). From 1 day after treatment, the Crs in VV-ECMO combined with PPV group was significantly higher than that before treatment (mL/cmHO: 21.20±1.50 vs. 17.91±0.82), the peak value was (24.93±2.18) mL/cmHO on 3 days after treatment, however, there was no significant difference between the two groups (all P < 0.05). In VV-ECMO combined with PPV group, compared with before PPV treatment, the PaO/FiO and Crs of 2 hours after PPV treatment in 1, 2 and 3 days were significantly rose, and it reached the highest level in 3 days [PaO/FiO (mmHg): 285.61±19.40 vs. 189.91±28.34, Crs (mL/cmHO): 24.93±2.18 vs. 23.35±1.45, both P < 0.05]; the VIS was only increased in 2 hours after PPV treatment on the first day than before (6.73±3.32 vs. 6.38±3.22, P < 0.05). There were no related serious adverse events happened after PPV treatment.
The combination of PPV during VV-ECMO could further increase PaO/FiO, improve hypoxemia and implement further protective lung ventilation to reduce the potential hazards during mechanical ventilation. In addition, no serious adverse events were observed in this study, suggesting PPV is safe during VV-ECMO.
观察静脉 - 静脉体外膜肺氧合（VV - ECMO）联合俯卧位通气（PPV）对重症急性呼吸窘迫综合征（ARDS）患者氧合指数（PaO₂/FiO₂）、呼吸顺应性（Crs）及血管活性药物使用评分（VIS）的影响。
选取2018年6月至2020年4月在柳州市人民医院需VV - ECMO支持的18例重症ARDS患者进行回顾性分析，其中8例在VV - ECMO后接受PPV。比较VV - ECMO组与VV - ECMO联合PPV组治疗前及治疗后1、2或3天的PaO₂/FiO₂、VIS和Crs差异，以及VV - ECMO联合PPV组每日PPV前及PPV后2小时这些指标的差异。同时观察两组不良事件的发生率。
治疗前，两组患者的PaO₂/FiO₂、Crs差异无统计学意义。随着时间推移，两组患者的PaO₂/FiO₂和Crs均升高，VIS降低。与治疗前相比，两组治疗后1天的PaO₂/FiO₂和VIS差异有统计学意义[PaO₂/FiO₂（mmHg，1 mmHg = 0.133 kPa）：VV - ECMO组为197.75±39.80 vs. 75.57±7.44，VV - ECMO联合PPV组为255.20±31.92 vs. 68.24±11.64；VIS：VV - ECMO组为5.51±3.72 vs. 10.20±7.10，VV - ECMO联合PPV组为6.73±3.32 vs. 14.50±2.48，均P < 0.05]，至治疗后3天仍有差异[PaO₂/FiO₂（mmHg）：VV - ECMO组为231.96±32.76 vs. 75.57±7.44，VV - ECMO联合PPV组为285.61±19.40 vs. 68.24±11.64；VIS：VV - ECMO组为2.26±1.90 vs. 10.20±7.10，VV - ECMO联合PPV组为2.13±1.55 vs. 14.50±2.48，均P < 0.05]，且VV - ECMO联合PPV组治疗后1天和3天的PaO₂/FiO₂显著高于VV - ECMO组（mmHg：治疗后1天为255.20±31.92 vs. 197.75±39.80，治疗后3天为285.61±19.40 vs. 231.96±32.76，均P < 0.05）。治疗前，VV - ECMO联合PPV组的Crs显著低于VV - ECMO组（mL/cmH₂O：17.91±0.82 vs. 20.54±1.26，P < 0.05）。治疗后1天起，VV - ECMO联合PPV组的Crs显著高于治疗前（mL/cmH₂O：21.20±1.50 vs. 17.91±0.82），治疗后3天达到峰值（24.93±2.18）mL/cmH₂O，但两组间差异无统计学意义（均P < 0.05）。在VV - ECMO联合PPV组中，与PPV治疗前相比，PPV治疗后1、2和3天2小时的PaO₂/FiO₂和Crs均显著升高，并在3天达到最高水平[PaO₂/FiO₂（mmHg）：285.61±19.40 vs. 189.91±28.34，Crs（mL/cmH₂O）：24.93±2.18 vs. 23.35±1.45，均P < 0.05]；VIS仅在第一天PPV治疗后2小时较前升高（6.73±3.32 vs. 6.38±3.22，P < 0.05）。PPV治疗后未发生相关严重不良事件。
VV - ECMO期间联合PPV可进一步提高PaO₂/FiO₂，改善低氧血症，实现进一步的肺保护性通气，减少机械通气期间的潜在危害。此外，本研究未观察到严重不良事件，提示PPV在VV - ECMO期间是安全的。
