Derespina Kim R, Medar Shivanand S, Aydin Scott I, Kaushik Shubhi, Al-Subu Awni, Ofori-Amanfo George
Division of Pediatric Critical Care Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, United States.
Division of Pediatric Critical Care Medicine, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, United States.
J Pediatr Intensive Care. 2020 Oct 5;11(2):109-113. doi: 10.1055/s-0040-1718375. eCollection 2022 Jun.
The kinetics of carbon dioxide elimination (VCO ) may be used as a surrogate for pulmonary blood flow. As such, we can apply a novel use of volumetric capnography to assess hemodynamic stability in patients requiring extracorporeal membrane oxygenation (ECMO). We report our experience of pediatric patients requiring ECMO support who were monitored using volumetric capnography. We describe the use of VCO and its association with successful decannulation. This is a prospective observational study of pediatric patients requiring ECMO support at The Children's Hospital at Montefiore from 2017 to 2019. A Respironics NM3 monitor was applied to each patient. Demographics, hemodynamic data, blood gases, and VCO (mL/min) data were collected. Data were collected immediately prior to and after decannulation. Over the course of the study period, seven patients were included. Predecannulation VCO was higher among patients who were successfully decannulated than nonsurvivors (109 [35, 230] vs. 12.4 [7.6, 17.2] mL/min), though not statistically significant. Four patients (57%) survived without further mechanical support; two (29%) died, and one (14%) was decannulated to Berlin. Predecannulation VCO appears to correlate with hemodynamic stability following decannulation. This case series adds to the growing literature describing the use of volumetric capnography in critical care medicine, particularly pediatric patients requiring ECMO. Prospective studies are needed to further elucidate the use of volumetric capnography and optimal timing for ECMO decannulation.
二氧化碳清除动力学（VCO₂）可作为肺血流量的替代指标。据此，我们可以将容积式二氧化碳描记法用于一种新的用途，即评估需要体外膜肺氧合（ECMO）的患者的血流动力学稳定性。我们报告了使用容积式二氧化碳描记法监测的需要ECMO支持的儿科患者的经验。我们描述了VCO₂的用途及其与成功拔管的关联。这是一项对2017年至2019年在蒙特菲奥里儿童医院需要ECMO支持的儿科患者进行的前瞻性观察研究。对每位患者应用了伟康NM3监护仪。收集了人口统计学、血流动力学数据、血气和VCO₂（毫升/分钟）数据。在拔管前后立即收集数据。在研究期间，共纳入7例患者。成功拔管的患者拔管前的VCO₂高于未存活者（109 [35, 230] 对比 12.4 [7.6, 17.2] 毫升/分钟），尽管差异无统计学意义。4例患者（57%）存活且无需进一步机械支持；2例（29%）死亡，1例（14%）拔管后转至柏林模式。拔管前的VCO₂似乎与拔管后的血流动力学稳定性相关。该病例系列丰富了越来越多描述容积式二氧化碳描记法在重症医学中应用的文献，尤其是在需要ECMO的儿科患者中。需要进行前瞻性研究以进一步阐明容积式二氧化碳描记法的用途以及ECMO拔管的最佳时机。
