Extracorporeal life support for 100 adult patients with severe respiratory failure
Extracorporeal life support for 100 adult patients with severe respiratory failure
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DOI：
10.1097/00000658-199710000-00015
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发表时间：
1997-10-01
影响因子：
9
通讯作者：
Bartlett, RH
中科院分区：
文献类型：
--
作者：
Kolla, S;Awad, SS;Bartlett, RH
目的回顾100例成人重症呼吸衰竭(ARF)患者的体外生命支持(ECLS)治疗经验，探讨ECLS的技术特点、疗效和应用，并确定预后预测因素。体外生命支持在婴幼儿呼吸衰竭的治疗中取得了成功。方法1990年1月至1996年7月，作者应用ECLS治疗成人重症急性呼吸衰竭(n=94)：P(A)O(2)/FiO2比值为55.7+/-15.9，经肺分流(Qs/Qt)为52+/-22%，或急性高碳酸盐呼吸衰竭(n=6)：P(A)CO(2)84.0+/-31.5 mm Hg。该技术包括经皮静脉通路、肺“休息”、ECLS转运、最小抗凝、血液滤过和最佳的全身氧气输送。持续时间为271.9+/-248.6小时。主要诊断包括肺炎(49例，存活率53%)、成人呼吸窘迫综合征(45例，存活率51%)和呼吸道支持(6例，存活率83%)。多因素Logistic回归模型确定了以下因素对预后有显著的独立预测作用：1)体外循环前机械通气天数(p=0.0003)，2)体外循环前p(A)O(2)/FiO2比率(p=0.002)，以及3)年龄(p=0.005)。体外循环期间的变量建模显示，没有机械性并发症是预后的独立预测因素，与预后相关的唯一与患者相关的并发症是肾功能衰竭(p<；0.0001)和严重的手术部位出血(p=0.0005)。结论体外生命支持为成人急性肾衰提供生命支持，使受损的肺有时间恢复。在100名被选为高死亡风险的患者中，尽管进行了最佳的常规治疗，但54%的患者存活了下来。体外生命支持是治疗成人严重呼吸衰竭的一种特殊而合理的方法。生存预测因素的存在可能对患者的预测和未来前瞻性研究的设计有用。
ObjectiveThe authors retrospectively reviewed their experience with extracorporeal life support (ECLS) in 100 adult patients with severe respiratory failure (ARF) to define techniques, characterize its efficacy and utilization, and determine predictors of outcome.Summary Background DataExtracorporeal life support maintains gas exchange during ARF, providing diseased lungs an optimal environment in which to heal. Extracorporeal life support has been successful in the treatment of respiratory failure in infants and children. In 1990, the authors instituted a standardized protocol for treatment of severe ARF in adults, which included ECLS when less invasive methods failed.MethodsFrom January 1990 to July 1996, the authors used ECLS for 100 adults with severe acute hypoxemic respiratory failure (n = 94): p(a)O(2)/FiO2 ratio of 55.7 +/- 15.9, transpulmonary shunt (Qs/Qt) of 52 +/- 22%, or acute hypercarbic respiratory failure (n = 6): p(a)CO(2) 84.0 +/- 31.5 mmHg, despite and after maximal conventional ventilation. The technique included venovenous percutaneous access, lung ''rest,'' transport on ECLS, minimal anticoagulation, hemofiltration, and optimal systemic oxygen delivery.ResultsOverall hospital survival was 54%. The duration of ECLS was 271.9 +/- 248.6 hours. Primary diagnoses included pneumonia (49 cases, 53% survived), adult respiratory distress syndrome (45 cases, 51% survived), and airway support (6 cases, 83% survived). Multivariate logistic regression modeling identified the following pre-ECLS variables significant independent predictors of outcome: 1) pre-ECLS days of mechanical ventilation (p = 0.0003), 2) pre-ECLS p(a)O(2)/FiO2 ratio (p = 0.002), and 3) age (years) (p = 0.005). Modeling of variables during ECLS showed that no mechanical complications were independent predictors of outcome, and the only patient-related complications associated with outcome were the presence of renal failure (p < 0.0001) and significant surgical site bleeding (p = 0.0005).ConclusionsExtracorporeal life support provides life support for ARF in adults, allowing time for injured lungs to recover. In 100 patients selected for high mortality risk despite and after optimal conventional treatment, 54% survived. Extracorporeal life support is extraordinary but reasonable treatment in severe adult respiratory failure. Predictors of survival exist that may be useful for patient prognostication and design of future prospective studies.