二氧化碳分压水平对行压力支持通气联合静脉-静脉体外膜肺氧合的呼吸衰竭患者器官灌注的影响：一项前瞻性研究。

The level of partial pressure of carbon dioxide affects organ perfusion in respiratory failure patients undergoing pressure support ventilation with venovenous extracorporeal membrane oxygenation: a prospective study.

机构信息

Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China.

Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.

出版信息

BMC Pulm Med. 2024 Aug 29;24(1):424. doi: 10.1186/s12890-024-03238-9.

DOI:10.1186/s12890-024-03238-9

PMID:39210298

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11363615/

Abstract

BACKGROUND

We evaluated the influence of different partial carbon dioxide pressure (PaCO) levels on organ perfusion in patients with respiratory failure receiving pressure-support ventilation with veno-venous extracorporeal membrane oxygenation (V-V ECMO).

METHODS

In this twelve patients prospective study, ECMO gas-flow was decreased from baseline (PaCO < 40 mmHg) until PaCO increased by 5-10 mmHg (High-CO phase). Resistance indices of gut, spleen, and snuffbox artery, the peripheral perfusion index (PPI), and heart rate variability were measured at baseline and High-CO phase.

RESULTS

When PaCO increased from 36 (36-37) mmHg at baseline to 42 (41-43) mmHg in the High-CO phase (p < 0.001), PPI decreased significantly (p = 0.026). The snuffbox artery (p = 0.022), superior mesenteric artery (p = 0.042), and spleen (p = 0.012) resistance indices increased significantly. The root mean square of successive differences (RMSSD) decreased from 19.5(18.1-22.7) to 15.9(14.4-18.6) ms (p = 0.034), and the ratio of low-frequency to high-frequency components(LF/HF) increased from 0.47 ± 0.23 to 0.70 ± 0.38 (p = 0.013).

CONCLUSIONS

High PaCO might cause decreased peripheral tissue and visceral organ perfusion through autonomic nervous system in patients with respiratory failure undergoing PSV with V-V ECMO.

摘要

背景

我们评估了不同部分二氧化碳压力（PaCO）水平对接受压力支持通气和静脉-静脉体外膜肺氧合（V-V ECMO）的呼吸衰竭患者器官灌注的影响。

方法

在这项十二名患者的前瞻性研究中，将 ECMO 气体流量从基线（PaCO < 40 mmHg）降低到 PaCO 增加 5-10 mmHg（高 CO 阶段）。在基线和高 CO 阶段测量了肠道、脾脏和鼻烟窝动脉的阻力指数、外周灌注指数（PPI）和心率变异性。

结果

当 PaCO 从基线时的 36（36-37）mmHg 增加到高 CO 阶段的 42（41-43）mmHg 时（p < 0.001），PPI 显著降低（p = 0.026）。鼻烟窝动脉（p = 0.022）、肠系膜上动脉（p = 0.042）和脾脏（p = 0.012）的阻力指数显著增加。连续差异的均方根（RMSSD）从 19.5（18.1-22.7）降至 15.9（14.4-18.6）ms（p = 0.034），低频与高频成分的比值（LF/HF）从 0.47 ± 0.23 增至 0.70 ± 0.38（p = 0.013）。