PDF(Pubmed)
Abstract：
UNASSIGNED: Extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) is systematically associated with decreased respiratory system compliance (CRS). It remains unclear whether transportation to the referral ECMO center, changes in ventilatory mode or settings to achieve ultra-protective ventilation, or the natural evolution of ARDS drives this change in respiratory mechanics. Herein, we assessed the precise moment when CRS decreases after ECMO cannulation and identified factors associated with decreased CRS.
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.
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.
摘要：
■用于急性呼吸窘迫综合征（ARDS）的体外膜氧合（ECMO）与呼吸系统依从性（CRS）降低有关。目前尚不清楚前往转诊ECMO中心的交通，改变通气模式或设置以实现超保护性通气，或者ARDS的自然进化推动了呼吸力学的这种变化。在这里，我们评估了ECMO插管后CRS减少的精确时刻,并确定了与CRS减少相关的因素.
■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。
■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。
