Very Low Driving-Pressure Ventilation in Patients With COVID-19 Acute Respiratory Distress Syndrome on Extracorporeal Membrane Oxygenation: A Physiologic Study.
Very Low Driving-Pressure Ventilation in Patients With COVID-19 Acute Respiratory Distress Syndrome on Extracorporeal Membrane Oxygenation: A Physiologic Study.
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COVID-19患者的急性呼吸窘迫综合征对体外膜氧合的急性呼吸窘迫综合征的驾驶压力通气非常低：一项生理研究。
DOI：
10.1053/j.jvca.2022.11.033
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发表时间：
2023-03
影响因子：
2.8
通讯作者：
中科院分区：
文献类型：
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作者：
在接受静脉-静脉体外膜肺氧合（VV ECMO）治疗的急性呼吸窘迫综合征（ARDS）患者中，确定降低驱动压（ΔP）是否会降低炎症和肺损伤的血浆生物标志物（白细胞介素-6 [IL-6]、IL-8和晚期糖基化终产物可溶性受体）。单中心前瞻性生理学研究。在一所大学的医疗中心。接受VV ECMO治疗的严重COVID-19 ARDS成人患者。VV ECMO参与者测量了以下生物标志物：（1）ECMO前伴低潮气量通气（LTVV），（2）ECMO后伴LTVV，（3）低驱动压通气（LDPV）期间，（4）极低驱动压通气（V-LDPV，主要干预ΔP = 1 cmH 2 O）2小时后，（5）返回LDPV后2小时。入组了26例受试者; 21例接受了V-LDPV。从LDPV到V-LDPV和从V-LDPV到LDPV，IL-6，IL-8和sIgA无显著变化。只有非自主呼吸的参与者（21例中的9例）的潮气量（Vt）（平均值± SD）发生了显著变化（p < 0.001），分别为1.9 ± 0.5、0.1 ± 0.2和2.0 ± 0.7 mL/kg预测体重（PBW）。自主呼吸受试者的Vt不变-4.5 ± 3.1、4.7 ± 3.1和5.6 ± 2.9 mL/kg PBW（分别为p = 0.481和p = 0.065）。当考虑Vt变化和生物标志物时，未发现相关性。在ECMO后的前24小时内，生物标志物没有显著变化，ΔPs或Vt变化降低。尽管有深度镇静，但由于自主呼吸，V-LDPV期间Vt的降低并不可靠。因此，尽管ΔPs或Vt较低，但接受VV ECMO治疗ARDS的患者的Vt（即，经肺动脉压）可能高于预期值。
To determine in patients with acute respiratory distress syndrome (ARDS) on venovenous extracorporeal membrane oxygenation (VV ECMO) whether reducing driving pressure (ΔP) would decrease plasma biomarkers of inflammation and lung injury (interleukin-6 [IL-6], IL-8, and the soluble receptor for advanced glycation end-products sRAGE). A single-center prospective physiologic study. At a single university medical center. Adult patients with severe COVID-19 ARDS on VV ECMO. Participants on VV ECMO had the following biomarkers measured: (1) pre-ECMO with low-tidal-volume ventilation (LTVV), (2) post-ECMO with LTVV, (3) during low-driving-pressure ventilation (LDPV), (4) after 2 hours of very low driving-pressure ventilation (V-LDPV, main intervention ΔP = 1 cmH2O), and (5) 2 hours after returning to LDPV. Twenty-six participants were enrolled; 21 underwent V-LDPV. There was no significant change in IL-6, IL-8, and sRAGE from LDPV to V-LDPV and from V-LDPV to LDPV. Only participants (9 of 21) with nonspontaneous breaths had significant change (p < 0.001) in their tidal volumes (Vt) (mean ± SD), 1.9 ± 0.5, 0.1 ± 0.2, and 2.0 ± 0.7 mL/kg predicted body weight (PBW). Participants with spontaneous breathing, Vt were unchanged—4.5 ± 3.1, 4.7 ± 3.1, and 5.6 ± 2.9 mL/kg PBW (p = 0.481 and p = 0.065, respectively). There was no relationship found when accounting for Vt changes and biomarkers. Biomarkers did not significantly change with decreased ΔPs or Vt changes during the first 24 hours post-ECMO. Despite deep sedation, reductions in Vt during V-LDPV were not reliably achieved due to spontaneous breaths. Thus, patients on VV ECMO for ARDS may have higher Vt (ie, transpulmonary pressure) than desired despite low ΔPs or Vt.
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影响因子：
8.8
作者：
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通讯作者：
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作者：
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DOI：
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