UNASSIGNED: To rule out the effect of transportation and the different modes of ventilation on CRS, we conducted a retrospective, single-center, observational cohort study from January 2013 to May 2020, on 22 patients with severe ARDS requiring on-site ECMO and ventilated in pressure-controlled mode to achieve ultra-protective ventilation. CRS was assessed at different time points ranging from 12 h before ECMO cannulation to 72 h after ECMO cannulation. The primary outcome was the relative change in CRS between 3 h before and 3 h after ECMO cannulation. The secondary outcomes included variables associated with the relative changes in CRS within the first 3 h after ECMO cannulation and the relative changes in CRS at each time point.
UNASSIGNED: CRS decreased within the first 3 h after ECMO cannulation (-28.3%, 95% confidence interval [CI]: -38.8 to -17.9, P<0.001), while the decrease was mild before and after these first 3 h after ECMO cannulation. To achieve ultra-protective ventilation, respiratory rate decreased in the mean by -13 breaths/min (95% CI: -15 to -11) and driving pressure by -8.3 cmH2O (95% CI: -11.2 to -5.3), resulting in decreased tidal volume by -3.3 mL/kg of predicted body weight (95% CI: -3.9 to -2.6) as compared to before ECMO cannulation (P <0.001 for all). Plateau pressure reduction, driving pressure reduction, and tidal volume reduction were significantly associated with decreased CRS after ECMO cannulation, whereas neither respiratory rate, positive end-expiratory pressure, inspired fraction of oxygen, fluid balance, nor mean airway pressure was associated with decreased CRS.
UNASSIGNED: Decreased driving pressure resulting in lower tidal volume to achieve ultra-protective ventilation after ECMO cannulation was associated with a marked decrease in CRS in ARDS patients with on-site ECMO cannulation.
■为了排除运输和不同的通风方式对CRS的影响,我们做了一个回顾,单中心,2013年1月至2020年5月的观察性队列研究,对象为22例重度ARDS患者,需要现场ECMO和以压力控制模式通气以实现超保护性通气.在ECMO插管前12小时至ECMO插管后72小时的不同时间点评估CRS。主要结果是ECMO插管前3小时和ECMO插管后3小时之间CRS的相对变化。次要结果包括与ECMO插管后的前3小时内CRS的相对变化以及每个时间点CRS的相对变化相关的变量。
■CRS在ECMO插管后的前3小时内下降(-28.3%,95%置信区间[CI]:-38.8至-17.9,P<0.001),而在ECMO插管后的前3小时前后,下降幅度很小。实现超保护性通风,呼吸频率平均下降-13次呼吸/分钟(95%CI:-15至-11),驱动压力下降-8.3cmH2O(95%CI:-11.2至-5.3),与ECMO插管前相比,潮气量减少了-3.3mL/kg预测体重(95%CI:-3.9至-2.6)(全部P<0.001)。高原减压,驱动减压,潮气量减少与ECMO插管后CRS减少显著相关,而没有呼吸频率,呼气末正压,吸入的氧气分数,流体平衡,平均气道压也与CRS降低相关。
■ECMO插管后,驱动压力降低导致潮气量降低以实现超保护性通气,这与ARDS患者的CRS明显减少相关。