Assouline Benjamin, Belli Gianlucca, Dorgham Karim, Moyon Quentin, Coppens Alexandre, Pineton de Chambrun Marc, Chommeloux Juliette, Levy David, Saura Ouriel, Hekimian Guillaume, Schmidt Matthieu, Combes Alain, Luyt Charles-Edouard
Sorbonne Université, Service de Médecine Intensive Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, France.
Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France.
J Crit Care. 2025 Feb;85:154945. doi: 10.1016/j.jcrc.2024.154945. Epub 2024 Nov 11.
Fever is frequent after extracorporeal membrane oxygenation (ECMO) decannulation. We aimed to evaluate the incidence of post-decannulation fever and describe its causes.
Adult ECMO patients who were successfully weaned from ECMO were retrospectively included. Minimal and maximal core temperatures were collected daily for each patient from 48 h before decannulation up to 5 days after. Patients were grouped according to the cause of fever (infection, thrombosis, or no evident cause) and compared. Plasma cytokine profile was obtained, each day from decannulation to 5 days after for 20 patients.
Between January 2021 and December 2022, 123 patients successfully weaned from ECMO were included. Post-decannulation fever occurred in 54 patients (44 %). It was associated with an infection in 39 patients (72 %) and with a thrombosis in 6 patients (11 %), and no cause was identified in the remaining 9 (17 %). Prolonged ECMO duration, extended ICU length-of-stay, diabetes and vascular comorbidities were significantly associated with a higher risk of infection. Finally, the pro-inflammatory cytokine profiles did not differ between febrile and afebrile patients.
Post-decannulation fever was common, and was mainly due to infections or thrombosis. Fever should therefore not be considered as a benign inflammatory reaction until proven otherwise.
体外膜肺氧合（ECMO）撤管后发热较为常见。我们旨在评估撤管后发热的发生率并描述其原因。
回顾性纳入成功脱离ECMO的成年ECMO患者。收集每位患者从撤管前48小时至撤管后5天每日的最低和最高核心体温。根据发热原因（感染、血栓形成或无明显原因）对患者进行分组并比较。对20例患者从撤管至撤管后5天每天获取血浆细胞因子谱。
2021年1月至2022年12月期间，纳入123例成功脱离ECMO的患者。54例患者（44%）发生撤管后发热。其中39例（72%）与感染有关，6例（11%）与血栓形成有关，其余9例（17%）未发现原因。ECMO持续时间延长、ICU住院时间延长、糖尿病和血管合并症与感染风险较高显著相关。最后，发热患者和未发热患者的促炎细胞因子谱无差异。
撤管后发热很常见，主要由感染或血栓形成引起。因此，在未证实其他原因之前，不应将发热视为良性炎症反应。
