PDF(Pubmed)
Abstract：
The kinetics of carbon dioxide elimination (VCO 2 ) may be used as a surrogate for pulmonary blood flow. As such, we can apply a novel use of volumetric capnography to assess hemodynamic stability in patients requiring extracorporeal membrane oxygenation (ECMO). We report our experience of pediatric patients requiring ECMO support who were monitored using volumetric capnography. We describe the use of VCO 2 and its association with successful decannulation. This is a prospective observational study of pediatric patients requiring ECMO support at The Children\'s Hospital at Montefiore from 2017 to 2019. A Respironics NM3 monitor was applied to each patient. Demographics, hemodynamic data, blood gases, and VCO 2 (mL/min) data were collected. Data were collected immediately prior to and after decannulation. Over the course of the study period, seven patients were included. Predecannulation VCO 2 was higher among patients who were successfully decannulated than nonsurvivors (109 [35, 230] vs. 12.4 [7.6, 17.2] mL/min), though not statistically significant. Four patients (57%) survived without further mechanical support; two (29%) died, and one (14%) was decannulated to Berlin. Predecannulation VCO 2 appears to correlate with hemodynamic stability following decannulation. This case series adds to the growing literature describing the use of volumetric capnography in critical care medicine, particularly pediatric patients requiring ECMO. Prospective studies are needed to further elucidate the use of volumetric capnography and optimal timing for ECMO decannulation.
摘要：
二氧化碳消除（VCO2）的动力学可用作肺血流的替代指标。因此，我们可以在需要体外膜氧合(ECMO)的患者中应用容积二氧化碳描记术的新用途来评估血流动力学稳定性.我们报告了需要ECMO支持的儿科患者的经验，这些患者使用体积二氧化碳描记术进行了监测。我们描述了VCO2的使用及其与成功拔管的关联。这是一项针对2017年至2019年在蒙特菲奥雷儿童医院需要ECMO支持的儿科患者的前瞻性观察性研究。对每个患者应用RespironicsNM3监测器。人口统计,血液动力学数据,血气,收集VCO2(mL/min)数据。在拔管之前和之后立即收集数据。在学习期间，包括7名患者。拔管前VCO2在成功拔管的患者中高于非幸存者（109[35，230]与12.4[7.6,17.2]mL/min),虽然没有统计学意义。四名患者（57％）在没有进一步机械支持的情况下存活；两名（29％）死亡，其中一人(14%)被撤到柏林。拔管前VCO2似乎与拔管后的血液动力学稳定性相关。这个案例系列增加了越来越多的文献描述了体积二氧化碳描记术在重症监护医学中的使用，特别是需要ECMO的儿科患者。需要进行前瞻性研究以进一步阐明体积二氧化碳描记术的使用以及ECMO拔管的最佳时机。
