体外二氧化碳去除 (ECCO2R) 在 COPD 和 ARDS 伴严重高碳酸血症呼吸衰竭患者中的应用。一项回顾性病例对照研究。
Extracorporeal carbon dioxide removal (ECCO2R) in COPD and ARDS patients with severe hypercapnic respiratory failure. A retrospective case-control study.
机构信息
Department of Internal Medicine Division of Critical Care, Faculty of Medicine, Trakya University, Edirne, Turkey
出版信息
Turk J Med Sci. 2021 Aug 30;51(4):2127-2135. doi: 10.3906/sag-2012-151.
BACKGROUND/AIM: Treatment of severe hypercapnic respiratory failure (HRF) has some challenges in patients with chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS), especially when lung protective ventilation (LPV) strategies are required. Extracorporeal CO2 removal (ECCO2R) therapy is an emerging option to manage hypercapnia while allowing LPV in these cases. However, further data on ECCO2R use is still needed to make clear recommendations.
MATERIALS AND METHODS
This study was conducted on patients admitted to intensive care unit (ICU) between January 1st, 2016 to December 31st, 2019. The medical records were retrospectively scanned in institutional software database. Patients who received invasive mechanic ventilation (iMV) support due to severe HRF related to COPD or ARDS were included in the analyses. Patients were grouped according to treatment approaches as that ECCO2R therapy in addition to conventional treatments and conventional treatments alone (controls). Groups were compared for 28-day survival, iMV duration, and length of stay (LOS).
RESULTS
ECCO2R therapy was noted in 75 of the cases among included 395 patients (COPD n = 256, ARDS n = 139) out of scanned 1715 medical records. The survival rate of ECCO2R patients was 68% and significantly higher than 58% survival rate of controls (p = 0.025), with relative risk reduction (RRR) = 0.16, absolute risk reduction (ARR)= 0.10, number need to treat (NNT) = 10, and odds ratio (OR) = 1.5. In addition, iMV duration (12.8 ± 2.6 vs. 17.1 ± 4.9 days, p = 0.007) and LOS (16.9 ± 4.1 vs. 18.9 ± 5.5 days, p = 0.032) were significantly shorter than controls. Repeated measure analyses showed that LPV settings were successfully provided by 72 h of ECCO2R therapy. Subgroup analyses according to diagnoses of COPD and ARDS also favored ECCO2R.
CONCLUSION
ECCO2R therapy significantly improved survival, iMV duration and LOS in patients with severe HRF due to COPD or ARDS, and successfully provided LPV approaches. Further studies are needed to assess promising benefits of ECCO2R therapy.
背景/目的：在慢性阻塞性肺疾病（COPD）和急性呼吸窘迫综合征（ARDS）患者中，治疗严重高碳酸血症性呼吸衰竭（HRF）存在一些挑战，尤其是需要肺保护性通气（LPV）策略时。体外 CO2 去除（ECCO2R）治疗是一种新兴的选择，可以在这些情况下管理高碳酸血症，同时允许 LPV。然而，仍需要更多关于 ECCO2R 使用的数据来明确建议。
材料和方法
本研究纳入了 2016 年 1 月 1 日至 2019 年 12 月 31 日期间入住重症监护病房（ICU）的患者。在机构软件数据库中回顾性扫描病历。纳入因 COPD 或 ARDS 相关严重 HRF 而接受有创机械通气（iMV）支持的患者进行分析。根据治疗方法将患者分为 ECCO2R 治疗联合常规治疗组和单纯常规治疗组（对照组）。比较两组 28 天生存率、iMV 持续时间和住院时间（LOS）。
结果
在扫描的 1715 份病历中，共纳入 395 例患者（COPD n = 256，ARDS n = 139），其中 75 例患者接受了 ECCO2R 治疗。ECCO2R 患者的生存率为 68%，明显高于对照组的 58%（p = 0.025），相对风险降低（RRR）= 0.16，绝对风险降低（ARR）= 0.10，需要治疗的人数（NNT）= 10，优势比（OR）= 1.5。此外，iMV 持续时间（12.8 ± 2.6 天 vs. 17.1 ± 4.9 天，p = 0.007）和 LOS（16.9 ± 4.1 天 vs. 18.9 ± 5.5 天，p = 0.032）明显短于对照组。重复测量分析显示，ECCO2R 治疗 72 小时内可成功提供 LPV 方法。根据 COPD 和 ARDS 的诊断进行亚组分析也有利于 ECCO2R。
结论
ECCO2R 治疗可显著改善 COPD 或 ARDS 所致严重 HRF 患者的生存率、iMV 持续时间和 LOS，并成功提供 LPV 方法。需要进一步研究评估 ECCO2R 治疗的潜在获益。
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