驱动压力对重症急性呼吸窘迫综合征患者启动和维持体外膜肺氧合的预后意义：一项系统评价和荟萃分析

Prognostic Significance of Driving Pressure for Initiation and Maintenance of ECMO in Patients with Severe ARDS: A Systematic Review and Meta-analysis.

作者信息

Todur Pratibha, Nileshwar Anitha, Chaudhuri Souvik, Nagendra Danavath, Shanbhag Vishal, Vennila J

机构信息

Department of Respiratory Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.

出版信息

Indian J Crit Care Med. 2025 Feb;29(2):177-185. doi: 10.5005/jp-journals-10071-24893. Epub 2025 Jan 31.

DOI:10.5005/jp-journals-10071-24893

PMID:40110140

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11915431/

Abstract

INTRODUCTION

In life-threatening conditions like severe acute respiratory distress syndrome (ARDS), rescue interventions like extracorporeal membrane oxygenation (ECMO) should be initiated urgently to resolve an otherwise potentially adverse clinical outcome. Driving pressure (DP) is an independent prognosticator of the survival of ARDS during mechanical ventilation. We conducted this review with the objective to identify the optimal DP for initiating ECMO in severe ARDS and to study the change in DP during ECMO strategy in survivors and non-survivors.

MATERIALS AND METHODS

A systematic search of EMBASE, PubMed, Cochrane Library, and SCOPUS databases was conducted from their inception to January 2024. Two investigators independently carried out the processes of literature search, study selection, data extraction, and quality assessment. The analysis was conducted using comprehensive meta-analysis software (CMA).

RESULTS

For meta-analysis, six studies comprising 668 patients were included. In survivors, the DP at ECMO initiation was lower (mean DP = 14.56 cm HO, 95% CI: [11.060-18.060]) than non-survivors (mean DP = 17.77 cm HO, 95% CI: [12.935-22.607]). During ECMO, the survivors had lower DP (mean DP = 11.63 cm HO, 95% CI: [10.070-13.195]) than non-survivors (mean DP = 14.67 cm HO, 95% CI: [12.810-15.831]).

CONCLUSION

The optimum DP to initiate ECMO in severe ARDS patients on MV is 15 cm HO. Extracorporeal membrane oxygenation reduces the intensity of MV, as reflected by a reduction in DP in both survivors and non-survivors during the ECMO by 3 cm HO. The DP ≤ 12 cm HO during ECMO strategy is a predictor of survival, and DP persisting ≥ 15 cm HO on ECMO prompts the search for strategies to reduce DP.

TRIAL REGISTRATION

PROSPERO CRD42022327846.

HOW TO CITE THIS ARTICLE

Todur P, Nileshwar A, Chaudhuri S, Nagendra D, Shanbhag V, Vennila J. Prognostic Significance of Driving Pressure for Initiation and Maintenance of ECMO in Patients with Severe ARDS: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2025;29(2):177-185.

摘要

引言

在诸如严重急性呼吸窘迫综合征（ARDS）等危及生命的情况下，应紧急启动诸如体外膜肺氧合（ECMO）等救援干预措施，以避免可能出现的不良临床结局。驱动压（DP）是ARDS患者机械通气期间生存的独立预测指标。我们进行这项综述的目的是确定在严重ARDS中启动ECMO的最佳驱动压，并研究幸存者和非幸存者在ECMO治疗策略期间驱动压的变化。

材料与方法

对EMBASE、PubMed、Cochrane图书馆和SCOPUS数据库从创建至2024年1月进行了系统检索。两名研究人员独立进行文献检索、研究选择、数据提取和质量评估过程。使用综合荟萃分析软件（CMA）进行分析。

结果

纳入荟萃分析的有6项研究，共668例患者。在幸存者中，启动ECMO时的驱动压较低（平均驱动压 = 14.56 cmH₂O，95%CI：[11.060 - 18.060]），低于非幸存者（平均驱动压 = 17.77 cmH₂O，95%CI：[12.935 - 22.607]）。在ECMO治疗期间，幸存者的驱动压较低（平均驱动压 = 11.63 cmH₂O，95%CI：[10.070 - 13.195]），低于非幸存者（平均驱动压 = 14.67 cmH₂O，95%CI：[12.810 - 15.831]）。

结论

在接受机械通气的严重ARDS患者中启动ECMO的最佳驱动压为15 cmH₂O。体外膜肺氧合降低了机械通气的强度，这在幸存者和非幸存者的ECMO治疗期间驱动压均降低3 cmH₂O中得到体现。ECMO治疗策略期间驱动压≤12 cmH₂O是生存的预测指标，而在ECMO上持续驱动压≥15 cmH₂O则促使寻找降低驱动压的策略。