Xuan Chenhao, Gu Jingxiao, Chen Jingyu, Xu Hongyang
Wuxi Medical Center, The Affiliated Wuxi People'S Hospital of Nanjing Medical University, Wuxi, 214023, Jiangsu, China.
Wuxi Lung Transplant Center, The Affiliated Wuxi People'S Hospital of Nanjing Medical University, Wuxi, 214023, Jiangsu, China.
Sci Rep. 2025 Mar 11;15(1):8421. doi: 10.1038/s41598-025-93396-5.
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) plays an important role in the perioperative care of critically ill lung transplant patients. However, the factors predicting prognosis are unclear. This study assessed the association between static respiratory compliance (Crs) and outcomes of lung transplant patients receiving VV-ECMO in terms of 90-day mortality. Data were retrospectively collected for patients that underwent lung transplantation with VV-ECMO support during 2022-2023. Patients were divided into two groups according to the early postoperative Crs: lower Crs (Crs < 25 ml/cmHO) and higher Crs (Crs ≥ 25 ml/cmHO). Differences in patient characteristics and prognosis were then compared between the two groups. Receiver operating characteristic (ROC) curve analysis was used to evaluate the value of Crs for predicting 90-day mortality and univariate Cox proportional hazard model analysis was performed to estimate risk of Crs. Data were available for a total of 85 patients, including 50 (58.8%) patients in the higher Crs group and 35 (41.2%) patients in the lower Crs group. A lower Crs was significantly associated with a longer postoperative ECMO duration (hours, 42 vs. 24; P = 0.022), longer postoperative ventilator time (days, 3.7 vs. 2.0; P = 0.003), higher application of continuous renal replacement therapy (CRRT) (20.0% vs. 6.0%; P = 0.049), higher incidence of pneumonia (42.9% vs. 20.0%; P = 0.023), and higher 90-day mortality (22.9% vs. 6.0%; P = 0.023). The area under the curve of Crs for predicting 90-day mortality was 0.661 (P = 0.034). A higher Crs was a protective factor (hazard ratio = 0.925 [0.870-0.984)] P = 0.014). For lung transplant patients receiving VV-ECMO support, Crs < 25 ml/cmHO is associated with more complications and higher 90-day mortality. As Crs is easily obtained at the bedside, it may be useful for predicting prognosis and guiding patient management.
静脉-静脉体外膜肺氧合（VV-ECMO）在重症肺移植患者的围手术期护理中起着重要作用。然而，预测预后的因素尚不清楚。本研究评估了静态呼吸顺应性（Crs）与接受VV-ECMO的肺移植患者90天死亡率结局之间的关联。回顾性收集了2022年至2023年期间接受VV-ECMO支持的肺移植患者的数据。根据术后早期Crs将患者分为两组：低Crs组（Crs<25ml/cmH₂O）和高Crs组（Crs≥25ml/cmH₂O）。然后比较两组患者的特征和预后差异。采用受试者工作特征（ROC）曲线分析评估Crs对预测90天死亡率的价值，并进行单因素Cox比例风险模型分析以估计Crs的风险。总共85例患者有可用数据，其中高Crs组50例（58.8%），低Crs组35例（41.2%）。较低的Crs与术后ECMO持续时间延长（小时数，42比24；P=0.022）、术后呼吸机使用时间延长（天数，3.7比2.0；P=0.003）、连续肾脏替代疗法（CRRT）应用率较高（20.0%比6.0%；P=0.049）、肺炎发生率较高（42.9%比20.0%；P=0.023）以及90天死亡率较高（22.9%比6.0%；P=0.023）显著相关。Crs预测90天死亡率的曲线下面积为0.661（P=0.034）。较高的Crs是一个保护因素（风险比=0.925[0.870-0.984]；P=0.014）。对于接受VV-ECMO支持的肺移植患者，Crs<25ml/cmH₂O与更多并发症和更高的90天死亡率相关。由于Crs可在床边轻松获得，它可能有助于预测预后并指导患者管理。
