Sun Kai-Peng, Zhou Si-Jia, Chen Xiu-Hua, Zheng Yi-Rong, Chen Qiang
Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
Transl Pediatr. 2024 Apr 30;13(4):575-583. doi: 10.21037/tp-23-485. Epub 2024 Apr 15.
The use of extracorporeal membrane oxygenation (ECMO) technology has significantly decreased mortality rates associated with neonatal pulmonary hypertension and respiratory failure. Prone positioning ventilation (PPV) is a commonly used technique in critically ill infants, designed to improve thoracic pressure gradients, re-expand dorsal lung segments, and increase oxygenation in approximately 70-80% of patients suffering from acute respiratory distress syndrome. This study aimed to evaluate the effects of PPV on pulmonary function in neonates undergoing venous-arterial extracorporeal membrane oxygenation (VA-ECMO).
We conducted a retrospective analysis of clinical data from 17 neonates who received ECMO support in our institution, divided into two groups based on ventilation strategy: ECMO with PPV (ECMO-PPV, n=8) and ECMO with supine positioning ventilation (ECMO-SPV, n=9). Parameters such as the P/F ratio [arterial oxygen partial pressure (PaO)/fraction of inspired oxygen (FiO)], oxygenation index (OI), respiratory system compliance (Crs), and airway resistance (RAW) were collected and analyzed at baseline, and at 1, 2, and 3 days post-ECMO initiation. In the ECMO-PPV group, these parameters were also assessed 3 days pre-treatment and 2 hours post-treatment initiation.
Initial comparisons between ECMO-PPV and ECMO-SPV groups showed no significant difference in PaO/FiO, OI, Crs, or RAW. Throughout the ECMO treatment, both groups demonstrated gradual improvements in PaO/FiO and Crs, and reductions in OI and RAW. Notably, by day 3, the ECMO-PPV group exhibited significant improvements in Crs and RAW compared to the ECMO-SPV group (P<0.05). Specifically, in the ECMO-PPV group, Crs significantly increased and RAW decreased after 2 hours of initiating PPV, with these changes becoming statistically significant by day 3 (Crs P=0.03, RAW P=0.03). No severe PPV-related complications were noted.
PPV during neonatal ECMO may improve respiratory compliance and reduce RAW, potentially aiding lung recovery. Our findings suggest PPV as a viable strategy for neonates under ECMO support.
体外膜肺氧合（ECMO）技术的应用显著降低了与新生儿肺动脉高压和呼吸衰竭相关的死亡率。俯卧位通气（PPV）是危重症婴儿常用的技术，旨在改善胸内压力梯度，使背侧肺段复张，并使约70-80%的急性呼吸窘迫综合征患者的氧合增加。本研究旨在评估PPV对接受静脉-动脉体外膜肺氧合（VA-ECMO）的新生儿肺功能的影响。
我们对在本院接受ECMO支持的17例新生儿的临床资料进行了回顾性分析，根据通气策略将其分为两组：PPV联合ECMO组（ECMO-PPV，n=8）和仰卧位通气联合ECMO组（ECMO-SPV，n=9）。在基线时以及ECMO启动后1天、2天和3天收集并分析动脉血氧分压（PaO）/吸入氧分数（FiO）、氧合指数（OI）、呼吸系统顺应性（Crs）和气道阻力（RAW）等参数。在ECMO-PPV组中，还在治疗前3天和治疗开始后2小时评估这些参数。
ECMO-PPV组和ECMO-SPV组之间的初始比较显示，PaO/FiO、OI、Crs或RAW无显著差异。在整个ECMO治疗过程中，两组的PaO/FiO和Crs均逐渐改善，OI和RAW均降低。值得注意的是，到第3天，与ECMO-SPV组相比，ECMO-PPV组的Crs和RAW有显著改善（P<0.05）。具体而言，在ECMO-PPV组中，启动PPV 2小时后Crs显著增加，RAW降低，到第3天这些变化具有统计学意义（Crs P=0.03，RAW P=0.03）。未发现严重的PPV相关并发症。
新生儿ECMO期间的PPV可能改善呼吸顺应性并降低RAW，可能有助于肺恢复。我们的研究结果表明PPV是ECMO支持下新生儿的一种可行策略。
