Tian Jing, Dong Yan, Zhou Tao, Zhang Jiayue, Xu Hongyang
Department of Critical Care Medicine, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214000, Jiangsu, China. Corresponding author: Xu Hongyang, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2024 May;36(5):538-542. doi: 10.3760/cma.j.cn121430-20231119-00989.
To evaluate the extracorporeal membrane oxygenation (ECMO) related outcomes during hospitalization during the intensive care unit (ICU) in idiopathic pulmonary fibrosis (IPF) patients with high body mass index (BMI, > 25 kg/m) undergoing lung transplantation with ECMO support.
A retrospective observational study was conducted. IPF patients who received ECMO during lung transplantation admitted to the Affiliated Wuxi People's Hospital of Nanjing Medical University from 2019 to 2020 were enrolled. Preoperative indicators including, demographics, comorbidities, arterial blood gas, and laboratory indicators; intraoperative indicators, such as lung lobe volume reduction, surgical type, surgical time, cold ischemia time, blood loss and transfusion volume; immediate indicators upon admission to the ICU, such as blood gas analysis and laboratory indicators; ECMO related outcomes, such as ECMO mode, ECMO support time, ECMO related complications (bleeding at the catheterization site, intraductal thrombosis, lower limb ischemia), and the length of ICU stay, duration of mechanical ventilation, and 30-day survival rate were collected. According to BMI, patients were divided into three groups: light weight group (BMI < 18.5 kg/m), normal weight group (BMI 18.5-24.9 kg/m), and overweight group (BMI ≥ 25.0 kg/m). Mainly to compare the relevant outcomes of ECMO among patients during ICU.
A total of 114 IPF patients who received ECMO support during lung transplantation were collected, including 23 cases in the light weight group, 63 cases in the normal weight group, and 28 cases in the overweight group. Compared with patients with underweight and normal weight, overweight patients were more likely to have hypertension (46.4% vs. 8.7%, 23.8%, P < 0.01) and coronary heart disease (32.1% vs. 4.3%, 20.6%, P < 0.05) before surgery, which was consistent with international guidelines for obesity. Other clinical data (preoperative, intraoperative, ICU characteristics) showed no statistically significant differences and were comparable. There was no statistically significant difference in terms of ECMO related outcomes, such as ECMO related complications [veno-venous (V-V) mode: 78.3%, 77.8%, 78.6%, veno-arterial (V-A) mode: 21.7%, 22.2%, 21.4%], ECMO support time (hours: 61.70±20.03, 44.57±5.76, 41.77±7.26), ECMO related complications (bleeding at the catheterization site: 4.3%, 7.9%, 14.3%; intraductal thrombosis: 8.7%, 12.7%, 17.9%; lower limb ischemia: 8.7%, 12.7%, 14.3%), and the length of ICU stay (days: 11±3, 7±1, 9±1), duration of mechanical ventilation [days: 2 (2, 11), 2 (2, 6), 3 (2, 8)] among the light weight group, normal weight group, and overweight group (all P > 0.05). Kaplan-Meier survival curve analysis showed that there was no statistically significant difference in the 30-day cumulative survival rate among the three groups (Log-Rank test: χ = 0.919, P = 0.632).
High BMI does not worsen ECMO-related outcomes or adversely affect early prognosis in IPF patients undergoing lung transplantation. BMI as a single parameter should not be a contraindication for the use of ECMO in lung transplantation surgery for IPF patients.
评估体重指数（BMI，>25kg/m²）较高的特发性肺纤维化（IPF）患者在接受体外膜肺氧合（ECMO）支持下进行肺移植时，重症监护病房（ICU）住院期间与ECMO相关的结局。
进行一项回顾性观察研究。纳入2019年至2020年在南京医科大学附属无锡人民医院接受肺移植期间接受ECMO治疗的IPF患者。收集术前指标，包括人口统计学、合并症、动脉血气和实验室指标；术中指标，如肺叶减容、手术类型、手术时间、冷缺血时间、失血量和输血量；入住ICU时的即时指标，如血气分析和实验室指标；与ECMO相关的结局，如ECMO模式、ECMO支持时间、ECMO相关并发症（置管部位出血、导管内血栓形成、下肢缺血），以及ICU住院时间、机械通气时间和30天生存率。根据BMI将患者分为三组：体重较轻组（BMI<18.5kg/m²）、正常体重组（BMI 18.5-24.9kg/m²）和超重组（BMI≥25.0kg/m²）。主要比较ICU期间患者ECMO的相关结局。
共收集114例在肺移植期间接受ECMO支持的IPF患者，其中体重较轻组23例，正常体重组63例，超重组28例。与体重过轻和正常体重的患者相比，超重患者术前更易患高血压（46.4%对8.7%、23.8%，P<0.01）和冠心病（32.1%对4.3%、20.6%，P<0.05），这与国际肥胖指南一致。其他临床数据（术前、术中、ICU特征）无统计学显著差异且具有可比性。体重较轻组、正常体重组和超重组在ECMO相关结局方面无统计学显著差异，如ECMO相关并发症[静脉-静脉（V-V）模式：78.3%、77.8%、78.6%，静脉-动脉（V-A）模式：21.7%、22.2%、21.4%]、ECMO支持时间（小时：61.70±20.03、44.57±5.76、41.77±7.26）、ECMO相关并发症（置管部位出血：4.3%、7.9%、14.3%；导管内血栓形成：8.7%、12.7%、17.9%；下肢缺血：8.7%、12.7%、14.3%），以及ICU住院时间（天：11±3、7±1、9±1）、机械通气时间[天：2（2，11）、2（2，6）、3（2，8）]（均P>0.05）。Kaplan-Meier生存曲线分析显示，三组的30天累积生存率无统计学显著差异（对数秩检验：χ²=0.919，P=0.632）。
高BMI不会使接受肺移植的IPF患者的ECMO相关结局恶化或对早期预后产生不利影响。BMI作为单一参数不应成为IPF患者肺移植手术中使用ECMO的禁忌证。
