Kim Sua, Kim Jooyun, Kim Saeyeon, Lee Ji-Hee, Kim YuJin, Hwang Jinwook, Shin Jae Seung, Kim Je Hyeong
Department of Critical Care Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea.
Division of Pulmonology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea.
J Clin Med. 2024 Dec 26;14(1):59. doi: 10.3390/jcm14010059.
A fever is an important sign that affects patient outcomes with various etiologies in the post-decannulation period of extracorporeal membrane oxygenation (ECMO); however, the cause is not fully understood. This study aimed to investigate the characteristics and clinical implications of fevers after ECMO decannulation in critically ill patients. We conducted a retrospective, single-center study of adult patients who were successfully weaned off venoarterial (VA) or venovenous (VV) ECMO. Decannulation fever was defined as fever that occurred within 72 h of ECMO decannulation. The peak and duration of fever were followed for 2 weeks after decannulation, and the relationship with infection was assessed. A total of 47 patients were included (22 [46.8%] on VA ECMO and 25 [53.2%] on VV ECMO). There were 35 (74.5%) patients who had decannulation fever, including 16 (34%) with active infections. Active infection during the study period was not related to the ECMO setting or duration; rather, infectious fever lasted longer than non-infectious fever (4 [interquartile range; IQR: 1-7] vs. 11 [IQR: 2-7] days, = 0.023), and the C-reactive protein level was higher on post-decannulation day 7 ( = 0.006). Active infection was associated with increased mortality (odds ratio [OR] 6.067, 95% confidence interval [CI] 1.1289-32.644, = 0.036), whereas decannulation fever was not (OR 0.156, 95% CI 0.025-0.977, = 0.047). Fever is an important indicator of ECMO decannulation. However, the different timing and duration of fevers during the post-decannulation period of ECMO may have various clinical implications.
发热是体外膜肺氧合（ECMO）撤机后影响不同病因患者预后的一个重要体征；然而，其病因尚未完全明确。本研究旨在调查危重症患者ECMO撤机后发热的特征及临床意义。我们对成功撤离静脉-动脉（VA）或静脉-静脉（VV）ECMO的成年患者进行了一项回顾性单中心研究。撤机发热定义为ECMO撤机后72小时内出现的发热。撤机后对发热的峰值和持续时间进行了2周的跟踪，并评估了其与感染的关系。共纳入47例患者（22例[46.8%]接受VA-ECMO，25例[53.2%]接受VV-ECMO）。有35例（74.5%）患者出现撤机发热，其中16例（34%）有活动性感染。研究期间的活动性感染与ECMO模式或持续时间无关；相反，感染性发热持续时间长于非感染性发热（4天[四分位间距；IQR：1-7] vs. 11天[IQR：2-7]，P=0.023），撤机后第7天C反应蛋白水平更高（P=0.006）。活动性感染与死亡率增加相关（比值比[OR] 6.067，95%置信区间[CI] 1.1289-32.644，P=0.036），而撤机发热则不然（OR 0.156，95%CI 0.025-0.977，P=0.047）。发热是ECMO撤机的一个重要指标。然而，ECMO撤机后不同时间和持续时间的发热可能具有不同的临床意义。
