Martucci Gennaro, Amata Michele, di Francesco Fabrizio, Traina Mario, Arcadipane Antonio, Lorusso Roberto, Granata Antonino
Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione) Palermo, Italy.
Endoscopy Service, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione) Palermo, Italy.
Endosc Int Open. 2021 Jun;9(6):E848-E852. doi: 10.1055/a-1399-8209. Epub 2021 May 27.
During extracorporeal membrane oxygenation (ECMO), intra-abdominal hypertension (IAH) can impair ECMO venous drainage, reducing its ability to provide an adequate oxygenated blood flow. When medical therapy is ineffective in managing IAH, guidelines recommend a decompressive laparotomy (DL), though the procedure is associated with several complications and poor outcomes. This was a case series of IAH in patients affected with acute respiratory distress syndrome (ARDS) on veno-venous (V-V) ECMO, in whom we performed total water-assisted colonoscopy (t-WAC) to treat IAH. In three patients who underwent t-WAC, we report a real-time intra-procedural reduction of IAH, normalization of ECMO blood flow, and a reduction of vasopressors and lactates. t-WAC was performed in the context of evident abdominal compartment syndrome with multiorgan failure, and in one case was performed because of IAH and ECMO impairment. One patient was discharged alive, while the other two died of multiorgan failure, although the cause of death was apparently not secondary to IAH. During ECMO, in select cases,T-WAC may represent a first-line non-invasive approach.
在体外膜肺氧合（ECMO）期间，腹腔内高压（IAH）会损害ECMO的静脉引流，降低其提供充足氧合血流的能力。当药物治疗对IAH无效时，指南建议进行减压剖腹术（DL），尽管该手术会引发多种并发症且预后不佳。这是一组关于急性呼吸窘迫综合征（ARDS）患者在静脉 - 静脉（V - V）ECMO支持下发生IAH的病例系列，我们对这些患者进行了全水辅助结肠镜检查（t - WAC）以治疗IAH。在接受t - WAC的三名患者中，我们报告了术中IAH实时降低、ECMO血流恢复正常以及血管升压药和乳酸水平降低的情况。t - WAC是在明显的腹腔间隔综合征合并多器官功能衰竭的情况下进行的，其中一例是因为IAH和ECMO功能受损而进行。一名患者存活出院，另外两名患者死于多器官功能衰竭，尽管死亡原因显然并非继发于IAH。在ECMO期间，在某些情况下，T - WAC可能代表一种一线非侵入性方法。
