Extracorporeal life support for severe acute respiratory distress syndrome in adults
Extracorporeal life support for severe acute respiratory distress syndrome in adults
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DOI：
10.1097/01.sla.0000141159.90676.2d
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发表时间：
2004-10-01
影响因子：
9
通讯作者：
Bartlett, RH
中科院分区：
文献类型：
--
作者：
Hemmila, MR;Rowe, SA;Bartlett, RH
目的：严重急性呼吸窘迫综合征（ARDS）与高死亡率相关。在重症ARDS患者中，体外生命支持（ECLS）维持氧气和二氧化碳气体交换，同时为肺功能恢复提供最佳环境。自1989年以来，我们一直使用方案驱动算法来治疗严重ARDS，其中包括在标准治疗失败时使用ECLS。本研究的目的是评估我们在严重急性呼吸窘迫综合征成人患者的死亡率和发病率方面使用ECLS的经验。方法：我们回顾了1989年1月1日至2003年12月31日成人ELCS的全部经验。重度ARDS定义为急性发作性肺衰竭，胸片双侧浸润，PaO2/吸入氧分数（FiO(2)）比小于或等于100或A-aDO(2) >600 mm Hg，尽管最大呼吸机设置。ECLS的适应症是对最佳常规治疗无反应的急性严重ARDS。ECLS技术包括静脉-静脉或静脉-动脉血管通路，肺在低FiO(2)和吸气压下“休息”，最小抗凝和优化全身氧输送。结果：在研究期间，405名17岁及以上的成人患者使用了ECLS。在这405例患者中，255例因严重ARDS对所有其他治疗都难治而接受ECLS治疗。67%的患者脱离了ECLS， 52%的患者存活至出院。多因素logistic回归分析发现以下elcs前变量是生存的重要独立预测因子：(1)年龄（P = 0.01）；(2)性别（P = 0.048）；(3) pH≤7.10 (P = 0.01)；(4) PaO2/FiO(2)比值（P = 0.03）；(5)机械通气天数（P < 0.001）。没有存活的患者需要永久性机械通气或补充氧气治疗。结论：对于常规机械呼吸机无应答的成人重症ARDS患者，体外生命支持是一种成功的治疗选择。
Objective: Severe acute respiratory distress syndrome (ARDS) is associated with a high level of mortality. Extracorporeal life support (ECLS) during severe ARDS maintains oxygen and carbon dioxide gas exchange while providing an optimal environment for recovery of pulmonary function. Since 1989, we have used a protocol-driven algorithm for treatment of severe ARDS, which includes the use of ECLS when standard therapy fails. The objective of this study was to evaluate our experience with ECLS in adult patients with severe ARDS with respect to mortality and morbidity.Methods: We reviewed our complete experience with ELCS in adults from January 1, 1989, through December 31, 2003. Severe ARDS was defined as acute onset pulmonary failure, with bilateral infiltrates on chest x-ray, and PaO2/fraction of inspired oxygen (FiO(2)) ratio less than or equal to100 or A-aDO(2) >600 mm Hg despite maximal ventilator settings. The indication for ECLS was acute severe ARDS unresponsive to optimal conventional treatment. The technique of ECLS included veno-venous or veno-arterial vascular access, lung "rest" at low FiO(2) and inspiratory pressure, minimal anticoagulation, and optimization of systemic oxygen delivery.Results: During the study period, ECLS was used for 405 adult patients age 17 or older. Of these 405 patients, 255 were placed on ECLS for severe ARDS refractory to all other treatment. Sixty-seven percent were weaned off ECLS, and 52% survived to hospital discharge. Multivariate logistic regression analysis identified the following pre-ELCS variables as significant independent predictors of survival: (1) age (P = 0.01); (2) gender (P = 0.048); (3) pH less than or equal to7.10 (P = 0.01); (4) PaO2/FiO(2) ratio (P = 0.03); and (5) days of mechanical ventilation (P < 0.001). None of the patients who survived required permanent mechanical ventilation or supplemental oxygen therapy.Conclusion: Extracorporeal life support for severe ARDS in adults is a successful therapeutic option in those patients who do not respond to conventional mechanical ventilator strategies.