Pilot study of extracorporeal carbon dioxide removal to facilitate extubation and ambulation in exacerbations of chronic obstructive pulmonary disease.
Pilot study of extracorporeal carbon dioxide removal to facilitate extubation and ambulation in exacerbations of chronic obstructive pulmonary disease.
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DOI：
10.1513/annalsats.201301-021oc
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发表时间：
2013-08-01
影响因子：
8.3
通讯作者：
Brodie, Daniel
中科院分区：
文献类型：
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作者：
Abrams, Darryl C;Brenner, Keith;Brodie, Daniel
基本原理：需要有创机械通气（IMV）的慢性阻塞性肺疾病（COPD）急性加重与显著的发病率和死亡率相关。体外二氧化碳清除（ECCO CORR）可能有助于这些患者的拔管和停药，并可能改善预后。结论：我们评估了使用单部位ECCO CORR在需要IMV治疗COPD急性加重的受试者中实现早期拔管和停药的可行性。5例COPD急性加重伴无代偿性高碳酸血症需要IMV的受试者入组了这项单中心、前瞻性、可行性试验采用ECCO CORR、拔管和身体康复方案。主要终点是开始ECCO监测后72小时内拔管。测量和主要结果：平均插管前pH和PaCO监测分别为7.23 ± 0.05和81.6 ± 15.9 mm Hg。所有受试者均符合主要终点（中位持续时间，4小时;范围，1.5-21.5小时）。体外支持的平均持续时间为193.0 ± 76.5小时。体外循环启动后至停药的平均时间为29.4 ± 12.6小时。在体外支持下的平均最大振幅为302英尺（范围，70-600）。4例受试者出院回家，1例接受计划的肺移植。发生2例轻微出血并发症。有没有并发症，从动员上的体外support.CONCLUSIONS：ECCO EARTHER有利于早期拔管和american在COPD急性加重需要IMV，并有可能作为一个新的范例，为管理一组选定的患者。需要严格的临床试验来证实这些结果，并调查对长期结果的影响和传统管理的成本效益。
RATIONALE: Acute exacerbations of chronic obstructive pulmonary disease (COPD) requiring invasive mechanical ventilation (IMV) are associated with significant morbidity and mortality. Extracorporeal carbon dioxide removal (ECCO₂R) may facilitate extubation and ambulation in these patients and potentially improve outcomes.OBJECTIVES: We assessed the feasibility of achieving early extubation and ambulation in subjects requiring IMV for exacerbations of COPD using single-site ECCO₂R.METHODS: Five subjects with exacerbations of COPD with uncompensated hypercapnia requiring IMV were enrolled in this single-center, prospective, feasibility trial using a protocol of ECCO₂R, extubation, and physical rehabilitation. The primary endpoint was extubation within 72 hours of starting ECCO₂R.MEASUREMENTS AND MAIN RESULTS: Mean preintubation pH and PaCO₂ were 7.23 ± 0.05 and 81.6 ± 15.9 mm Hg, respectively. All subjects met the primary endpoint (median duration, 4 h; range, 1.5-21.5 h). Mean duration of extracorporeal support was 193.0 ± 76.5 hours. Mean time to ambulation after extracorporeal initiation was 29.4 ± 12.6 hours. Mean maximal ambulation on extracorporeal support was 302 feet (range, 70-600). Four subjects were discharged home, and one underwent planned lung transplantation. Two minor bleeding complications occurred. There were no complications from mobilization on extracorporeal support.CONCLUSIONS: ECCO₂R facilitates early extubation and ambulation in exacerbations of COPD requiring IMV and has the potential to serve as a new paradigm for the management of a select group of patients. Rigorous clinical trials are needed to corroborate these results and to investigate the effect on long-term outcomes and cost effectiveness over conventional management.