Prone positioning in severe ARDS requiring extracorporeal membrane oxygenation
Prone positioning in severe ARDS requiring extracorporeal membrane oxygenation
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DOI：
10.1186/s13054-020-03110-2
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发表时间：
2020-07-08
期刊：
影响因子：
15.1
通讯作者：
Wengenmayer, Tobias
中科院分区：
文献类型：
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作者：
Rilinger, Jonathan;Zotzmann, Viviane;Wengenmayer, Tobias
研究背景俯卧位（PP）可以提高严重急性呼吸窘迫综合征（ARDS）患者的生存率。到目前为止，尚不清楚PP是否也有利于接受静脉-静脉体外膜肺氧合（VV ECMO）支持治疗的ARDS患者。方法我们报告了2010年10月至2018年5月期间需要VV ECMO支持的重度ARDS患者的单中心登记研究的回顾性数据。如果在VV ECMO治疗期间进行PP，则将患者分配至PP组或仰卧位组。分析倾向评分匹配前后VV ECMO撤机成功率和住院生存率。结果共158例患者可进行分析，38例（24.1%）患者接受了PP。俯卧和仰卧组之间VV ECMO脱机率（47.4% vs. 46.7%，p = 0.94）和住院生存率（36.8% vs. 36.7%，p = 0.98）无显著差异。对38个倾向评分匹配对的分析也显示，住院生存率（36.8% vs. 36.8%，p = 1.0）或VV ECMO撤机率（47.4% vs. 44.7%，p = 0.82）无差异。与晚期或无PP治疗的患者相比，接受早期PP治疗的患者亚组（根据Youden指数，截止时间< 17 h）的住院生存率上级（81.8% vs. 33.3%，p = 0.02）。结论在这个倾向评分匹配的需要VV ECMO支持的严重ARDS患者队列中，任何时候俯卧位与脱机或生存率的改善无关。然而，早期开始俯卧位与住院死亡率的显著降低有关。
Background Prone positioning (PP) has shown to improve survival in patients with severe acute respiratory distress syndrome (ARDS). To this point, it is unclear if PP is also beneficial for ARDS patients treated with veno-venous extracorporeal membrane oxygenation (VV ECMO) support. Methods We report retrospective data of a single-centre registry of patients with severe ARDS requiring VV ECMO support between October 2010 and May 2018. Patients were allocated to the PP group if PP was performed during VV ECMO treatment or the supine positioning group. VV ECMO weaning success and hospital survival were analysed before and after propensity score matching. Results A total of 158 patients could be analysed, and 38 patients (24.1%) received PP. There were no significant differences in VV ECMO weaning rate (47.4% vs. 46.7%,p = 0.94) and hospital survival (36.8% vs. 36.7%,p = 0.98) between the prone and supine groups, respectively. The analysis of 38 propensity score matched pairs also showed no difference in hospital survival (36.8% vs. 36.8%,p = 1.0) or VV ECMO weaning rate (47.4% vs. 44.7%,p = 0.82). Hospital survival was superior in the subgroup of patients treated with early PP (cutoff < 17 h via Youden's Index) as compared to late or no PP (81.8% vs. 33.3%,p = 0.02). Conclusion In this propensity score matched cohort of severe ARDS patients requiring VV ECMO support, prone positioning at any time was not associated with improved weaning or survival. However, early initiation of prone positioning was linked to a significant reduction of hospital mortality.