Fumagalli Benedetta, Giani Marco, Bombino Michela, Fumagalli Denise, Merelli Milena, Chiesa Gaia, Rona Roberto, Bellani Giacomo, Rezoagli Emanuele, Foti Giuseppe
From Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Department of Emergency and Intensive Care, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy.
ASAIO J. 2025 Feb 1;71(2):171-176. doi: 10.1097/MAT.0000000000002285. Epub 2024 Aug 8.
In the initial phases of veno-venous extracorporeal membrane oxygenation (VV ECMO) support for severe acute respiratory distress syndrome (ARDS), ultraprotective controlled mechanical ventilation (CMV) is typically employed to limit the progression of lung injury. As patients recover, transitioning to assisted mechanical ventilation can be considered to reduce the need for prolonged sedation and paralysis. This study aimed to evaluate the feasibility of transitioning to pressure support ventilation (PSV) during VV ECMO and to explore variations in respiratory mechanics and oxygenation parameters following the transition to PSV. This retrospective monocentric study included 191 adult ARDS patients treated with VV ECMO between 2009 and 2022. Within this population, 131 (69%) patients were successfully switched to PSV during ECMO. Pressure support ventilation was associated with an increase in respiratory system compliance ( p = 0.02) and a reduction in pulmonary shunt fraction ( p < 0.001). Additionally, improvements in the cardiovascular Sequential Organ Failure Assessment score and a reduction in pulmonary arterial pressures ( p < 0.05) were recorded. Ninety-four percent of patients who successfully transitioned to PSV were weaned from ECMO, and 118 (90%) were discharged alive from the intensive care unit (ICU). Of those who did not reach PSV, 74% died on ECMO, whereas the remaining patients were successfully weaned from extracorporeal support. In conclusion, PSV is feasible during VV ECMO and potentially correlates with improvements in respiratory function and hemodynamics.
在采用静脉-静脉体外膜肺氧合（VV ECMO）支持治疗严重急性呼吸窘迫综合征（ARDS）的初始阶段，通常采用超保护性控制机械通气（CMV）来限制肺损伤的进展。随着患者康复，可以考虑过渡到辅助机械通气，以减少长期镇静和麻痹的需求。本研究旨在评估在VV ECMO期间过渡到压力支持通气（PSV）的可行性，并探讨过渡到PSV后呼吸力学和氧合参数的变化。这项回顾性单中心研究纳入了2009年至2022年间接受VV ECMO治疗的191例成年ARDS患者。在这一人群中，131例（69%）患者在ECMO期间成功转换为PSV。压力支持通气与呼吸系统顺应性增加（p = 0.02）和肺分流分数降低（p < 0.001）相关。此外，还记录到心血管序贯器官衰竭评估评分有所改善，肺动脉压降低（p < 0.05）。成功过渡到PSV的患者中有94%撤机，118例（90%）从重症监护病房（ICU）存活出院。未达到PSV的患者中，74%在ECMO期间死亡，其余患者成功撤机。总之，在VV ECMO期间PSV是可行的，并且可能与呼吸功能和血流动力学的改善相关。
