PDF(Pubmed)
Abstract：
UNASSIGNED: The use of extracorporeal membrane oxygenation (ECMO) technology has significantly decreased mortality rates associated with neonatal pulmonary hypertension and respiratory failure. Prone positioning ventilation (PPV) is a commonly used technique in critically ill infants, designed to improve thoracic pressure gradients, re-expand dorsal lung segments, and increase oxygenation in approximately 70-80% of patients suffering from acute respiratory distress syndrome. This study aimed to evaluate the effects of PPV on pulmonary function in neonates undergoing venous-arterial extracorporeal membrane oxygenation (VA-ECMO).
UNASSIGNED: We conducted a retrospective analysis of clinical data from 17 neonates who received ECMO support in our institution, divided into two groups based on ventilation strategy: ECMO with PPV (ECMO-PPV, n=8) and ECMO with supine positioning ventilation (ECMO-SPV, n=9). Parameters such as the P/F ratio [arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (FiO2)], oxygenation index (OI), respiratory system compliance (Crs), and airway resistance (RAW) were collected and analyzed at baseline, and at 1, 2, and 3 days post-ECMO initiation. In the ECMO-PPV group, these parameters were also assessed 3 days pre-treatment and 2 hours post-treatment initiation.
UNASSIGNED: Initial comparisons between ECMO-PPV and ECMO-SPV groups showed no significant difference in PaO2/FiO2, OI, Crs, or RAW. Throughout the ECMO treatment, both groups demonstrated gradual improvements in PaO2/FiO2 and Crs, and reductions in OI and RAW. Notably, by day 3, the ECMO-PPV group exhibited significant improvements in Crs and RAW compared to the ECMO-SPV group (P<0.05). Specifically, in the ECMO-PPV group, Crs significantly increased and RAW decreased after 2 hours of initiating PPV, with these changes becoming statistically significant by day 3 (Crs P=0.03, RAW P=0.03). No severe PPV-related complications were noted.
UNASSIGNED: PPV during neonatal ECMO may improve respiratory compliance and reduce RAW, potentially aiding lung recovery. Our findings suggest PPV as a viable strategy for neonates under ECMO support.
UNASSIGNED: We conducted a retrospective analysis of clinical data from 17 neonates who received ECMO support in our institution, divided into two groups based on ventilation strategy: ECMO with PPV (ECMO-PPV, n=8) and ECMO with supine positioning ventilation (ECMO-SPV, n=9). Parameters such as the P/F ratio [arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (FiO2)], oxygenation index (OI), respiratory system compliance (Crs), and airway resistance (RAW) were collected and analyzed at baseline, and at 1, 2, and 3 days post-ECMO initiation. In the ECMO-PPV group, these parameters were also assessed 3 days pre-treatment and 2 hours post-treatment initiation.
UNASSIGNED: Initial comparisons between ECMO-PPV and ECMO-SPV groups showed no significant difference in PaO2/FiO2, OI, Crs, or RAW. Throughout the ECMO treatment, both groups demonstrated gradual improvements in PaO2/FiO2 and Crs, and reductions in OI and RAW. Notably, by day 3, the ECMO-PPV group exhibited significant improvements in Crs and RAW compared to the ECMO-SPV group (P<0.05). Specifically, in the ECMO-PPV group, Crs significantly increased and RAW decreased after 2 hours of initiating PPV, with these changes becoming statistically significant by day 3 (Crs P=0.03, RAW P=0.03). No severe PPV-related complications were noted.
UNASSIGNED: PPV during neonatal ECMO may improve respiratory compliance and reduce RAW, potentially aiding lung recovery. Our findings suggest PPV as a viable strategy for neonates under ECMO support.
摘要：
■体外膜氧合（ECMO）技术的使用显着降低了与新生儿肺动脉高压和呼吸衰竭相关的死亡率。俯卧位通气（PPV）是危重患儿常用的技术，旨在改善胸腔压力梯度，肺背段再扩张,约70-80％的急性呼吸窘迫综合征患者的氧合增加。本研究旨在评估PPV对接受静脉-动脉体外膜氧合（VA-ECMO）的新生儿肺功能的影响。
■我们对在我们机构接受ECMO支持的17例新生儿的临床数据进行了回顾性分析，根据通气策略分为两组：ECMO+PPV(ECMO-PPV，n=8)和仰卧位通气的ECMO(ECMO-SPV，n=9)。P/F比[动脉氧分压（PaO2）/吸入氧气分数（FiO2）]等参数，氧合指数（OI），呼吸系统顺应性（Crs），收集并分析基线时的气道阻力（RAW），以及ECMO启动后1、2和3天。在ECMO-PPV组中，这些参数也在治疗前3天和治疗开始后2小时进行了评估.
■ECMO-PPV和ECMO-SPV组之间的初步比较显示PaO2/FiO2，OI，Crs,或RAW。在整个ECMO治疗过程中，两组均显示PaO2/FiO2和Crs逐渐改善，以及OI和RAW的减少。值得注意的是,到第3天，与ECMO-SPV组相比，ECMO-PPV组的Crs和RAW显着改善（P<0.05）。具体来说,在ECMO-PPV组中，开始PPV2小时后，Crs显着增加，RAW降低，这些变化在第3天变得具有统计学意义（CrsP=0.03，RAWP=0.03）。未发现严重的PPV相关并发症。
■新生儿ECMO期间的PPV可以改善呼吸顺应性并降低RAW，有可能帮助肺部恢复.我们的发现表明PPV是ECMO支持下新生儿的可行策略。
■我们对在我们机构接受ECMO支持的17例新生儿的临床数据进行了回顾性分析，根据通气策略分为两组：ECMO+PPV(ECMO-PPV，n=8)和仰卧位通气的ECMO(ECMO-SPV，n=9)。P/F比[动脉氧分压（PaO2）/吸入氧气分数（FiO2）]等参数，氧合指数（OI），呼吸系统顺应性（Crs），收集并分析基线时的气道阻力（RAW），以及ECMO启动后1、2和3天。在ECMO-PPV组中，这些参数也在治疗前3天和治疗开始后2小时进行了评估.
■ECMO-PPV和ECMO-SPV组之间的初步比较显示PaO2/FiO2，OI，Crs,或RAW。在整个ECMO治疗过程中，两组均显示PaO2/FiO2和Crs逐渐改善，以及OI和RAW的减少。值得注意的是,到第3天，与ECMO-SPV组相比，ECMO-PPV组的Crs和RAW显着改善（P<0.05）。具体来说,在ECMO-PPV组中，开始PPV2小时后，Crs显着增加，RAW降低，这些变化在第3天变得具有统计学意义（CrsP=0.03，RAWP=0.03）。未发现严重的PPV相关并发症。
■新生儿ECMO期间的PPV可以改善呼吸顺应性并降低RAW，有可能帮助肺部恢复.我们的发现表明PPV是ECMO支持下新生儿的可行策略。
