体外膜肺氧合支持可能与结核相关严重 ARDS 的生存率提高有关。

ECMO support may be associated with improved survival in tuberculosis associated severe ARDS.

机构信息

Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.

Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover Medical School (MHH), German Center for Lung Research (DZL), Hannover, Germany.

出版信息

BMC Pulm Med. 2024 Oct 24;24(1):530. doi: 10.1186/s12890-024-03356-4.

DOI:10.1186/s12890-024-03356-4

PMID:39448941

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11515833/

Abstract

BACKGROUND

Data describing outcome of extracorporeal membrane oxygenation (ECMO) support in Tuberculosis (Tbc)-associated acute respiratory distress syndrome (ARDS) remain sparce and are mostly confined to singular case reports. The aim of this case series was to analyze intensive care unit (ICU) survival in patients with Tbc-associated ARDS receiving veno-venous (vv-) ECMO support and to compare those to patients not receiving ECMO.

CASE PRESENTATION

ICU survival was analyzed retrospectively in 14 patients treated for Tbc-associated ARDS at three ECMO-referral university hospitals (Hannover Medical School, University Hospital Bonn (both Germany) and University Hospital Zurich (Switzerland)) during the last 14 years, of which eight patients received additional vv-ECMO support and six standard care only. ICU survival was significantly higher in patients receiving additional vv-ECMO support (62.5%, n = 5/8) compared to those that did not (16.7%, n = 1/6) (p = 0.021). ECMO support was associated with reduced ICU mortality (Hazard ratio adjusted for baseline SOFA score [adj. HR] 0.125 (95% confidence interval (CI): 0.023-0.689), p = 0.017). Median (IQR) time on ECMO and invasive ventilation in the vv-ECMO group were 20 (11-26) and 37 (27-53) days, respectively. Major bleeding defined as transfusion requirement of 4 units of blood or more or surgical and/or radiologic intervention occurred only in one patient, in whom pulmonary bleeding was fatal. Thromboembolic events occurred in none of the vv-ECMO patients.

DISCUSSION AND CONCLUSIONS

This retrospective analysis from three large ECMO centers with similar SOPs suggests vv-ECMO support as a feasible approach in patients with severe Tbc-associated ARDS. Although affiliated with extended runtimes, vv-ECMO might be associated with improved survival in those patients. Vv-ECMO support should thus be considered in Tbc-associated ARDS to enable lung protective strategies during prolonged lung recovery.

摘要

背景

有关体外膜肺氧合（ECMO）支持在结核病（Tbc）相关急性呼吸窘迫综合征（ARDS）患者中的治疗效果的数据仍然很少，且大多局限于单一病例报告。本病例系列研究的目的是分析接受静脉-静脉（vv-）ECMO 支持的 Tbc 相关 ARDS 患者在重症监护病房（ICU）的存活率，并将其与未接受 ECMO 治疗的患者进行比较。

病例介绍

在过去 14 年中，3 家 ECMO 转诊大学医院（德国汉诺威医学院、波恩大学医院（均为德国）和苏黎世大学医院（瑞士））共收治了 14 例 Tbc 相关 ARDS 患者，对其中 8 例患者接受了额外的 vv-ECMO 支持，6 例患者仅接受了标准治疗，回顾性分析了 ICU 存活率。接受额外 vv-ECMO 支持的患者 ICU 存活率明显高于未接受者（62.5%，8/13 例 vs. 16.7%，6/37 例）（p=0.021）。ECMO 支持与 ICU 死亡率降低相关（调整了基线 SOFA 评分的风险比 [adj. HR] 0.125（95%置信区间 [CI]：0.023-0.689），p=0.017）。vv-ECMO 组患者 ECMO 和有创通气的中位（IQR）时间分别为 20（11-26）和 37（27-53）天。仅 1 例患者发生了定义为输注 4 个单位以上血液或需要手术和/或放射介入治疗的大出血，该患者的肺出血导致死亡。vv-ECMO 患者均未发生血栓栓塞事件。

讨论与结论

本研究回顾性分析了 3 家采用类似 SOP 的大型 ECMO 中心的数据，结果提示 vv-ECMO 支持可能是治疗严重 Tbc 相关 ARDS 患者的一种可行方法。尽管与延长运行时间有关，但 vv-ECMO 可能与这些患者的生存率提高相关。因此，在 Tbc 相关 ARDS 患者中应考虑 vv-ECMO 支持，以在长时间的肺恢复期间实现肺保护性策略。