静脉-静脉体外膜肺氧合对重症急性呼吸窘迫综合征右心室功能损害的影响：一项前瞻性观察性纵向研究
Impact of Veno-Venous Extracorporeal Membrane Oxygenation on Right Ventricular Impairment in Severe ARDS: A Prospective Observational Longitudinal Study.
作者信息
Conrad Alice Marguerite, Duerschmied Daniel, Boesing Christoph, Thiel Manfred, Beck Grietje, Luecke Thomas, Rocco Patricia R M, Krebs Joerg, Loosen Gregor
机构信息
Department of Anaesthesiology and Critical Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.
Department of Cardiology, Angiology, Haemostaseology, and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
出版信息
J Intensive Care Med. 2025 Jun 30:8850666251352445. doi: 10.1177/08850666251352445.
PurposeRight ventricular impairment (RVI) can be alleviated by the initiation of veno-venous extracorporeal membrane oxygenation (V-V ECMO), which enhances gas exchange and allows for less invasive mechanical ventilation. However, the progression of RVI during V-V ECMO remains unclear. This study assesses echocardiographic changes in RVI over a five-day period in twenty acute respiratory distress syndrome (ARDS) patients with V-V ECMO support.Material and MethodsOver a five-day period of V-V ECMO support, we examined echocardiographic markers of RVI, including right and left ventricular end-diastolic area ratio (RVEDA/LVEDA), tricuspid annular plane systolic excursion (TAPSE), tricuspid valve lateral anulus peak systolic velocity ('), right ventricular fractional area change (FAC), and right ventricular myocardial performance index. Secondary objectives included changes in mechanical power transmitted to the respiratory system, hemodynamics and gas-exchange.ResultsRVEDA/LVEDA ratio remained elevated (0.8 [0.7-0.8] vs 0.7 [0.7-0.9]; = .986), TAPSE decreased (2.0[1.6-2.5] cm vs 1.7 [1.4-2.2] cm; = .024) while no changes were observed in ' (16 [13-21] cm/s vs 15 [12-18] cm/s; = .136) and FAC (38 [27-47] % vs 36 [29-43] %; = .627). The right ventricular myocardial performance index improved (0.74 [0.45-1.00] vs 0.51 [0.42-0.80]; = .004). Lung mechanical power was significantly reduced due to a decrease in lung elastic and resistive components.ConclusionsDespite preserved longitudinal function and improved global performance, RVI persisted in severe ARDS patients on V-V ECMO, as indicated by the RVEDA/LVEDA ratio. These findings suggest that mechanisms beyond hypoxemia, hypercapnia and the invasiveness of mechanical ventilation contribute to RVI in these patients.Trial registrationThis trial was registered with the German Clinical Trials Register (DRKS00028584) on March 28, 2022. https://drks.de/search/en/trial/DRKS00028584.
目的
静脉-静脉体外膜肺氧合（V-V ECMO）的启动可缓解右心室功能障碍（RVI），它能增强气体交换并允许采用侵入性较小的机械通气。然而，V-V ECMO期间RVI的进展仍不清楚。本研究评估了20例接受V-V ECMO支持的急性呼吸窘迫综合征（ARDS）患者在五天内RVI的超声心动图变化。
材料与方法
在V-V ECMO支持的五天期间，我们检查了RVI的超声心动图指标，包括右心室与左心室舒张末期面积比（RVEDA/LVEDA）、三尖瓣环平面收缩期位移（TAPSE）、三尖瓣外侧瓣环收缩期峰值速度（'）、右心室面积变化分数（FAC）和右心室心肌性能指数。次要目标包括传递至呼吸系统的机械功率、血流动力学和气体交换的变化。
结果
RVEDA/LVEDA比值仍升高（0.8[0.7 - 0.8]对0.7[0.7 - 0.9]；P = 0.986），TAPSE降低（2.0[1.6 - 2.5]cm对1.7[1.4 - 2.2]cm；P = 0.024），而'（16[13 - 21]cm/s对15[12 - 18]cm/s；P = 0.136）和FAC（38[27 - 47]%对36[29 - 43]%；P = 0.627）无变化。右心室心肌性能指数改善（0.74[0.45 - 1.00]对0.51[0.42 - 0.80]；P = 0.004）。由于肺弹性和阻力成分的降低，肺机械功率显著降低。
结论
尽管纵向功能得以保留且整体性能有所改善，但如RVEDA/LVEDA比值所示，接受V-V ECMO的重症ARDS患者的RVI仍然存在。这些发现表明，除低氧血症、高碳酸血症和机械通气的侵入性之外的机制导致了这些患者的RVI。
试验注册
本试验于2022年3月28日在德国临床试验注册中心（DRKS00028584）注册。https://drks.de/search/en/trial/DRKS00028584 。
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