Mechanical ventilation during extracorporeal membrane oxygenation.
Mechanical ventilation during extracorporeal membrane oxygenation.
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DOI：
10.1186/cc13702
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发表时间：
2014-01-21
期刊：
影响因子：
--
通讯作者：
Hodgson C
中科院分区：
文献类型：
--
作者：
Schmidt M;Pellegrino V;Combes A;Scheinkestel C;Cooper DJ;Hodgson C
体外膜肺氧合（ECMO）的启动时间及其在呼吸和心力衰竭管理中的结果受到了相当大的关注，但ECMO期间的机械通气很少受到关注。非ECMO研究中的机械通气设置已被证明对生存率有影响，也可能有助于ECMO试验中的治疗效果。为非ECMO支持的呼吸衰竭患者建立的保护性肺通气策略可能不适用于需要ECMO支持的更严重形式的呼吸衰竭。呼气末正压对左心室顺应性降低的影响可能是接受ECMO支持的心力衰竭患者关注的问题。本综述的目的是描述ECMO治疗呼吸或心力衰竭期间肺损伤的潜在机制，评估使用超保护性肺通气策略的可能获益，并回顾已发表的指南和专家意见，这些指南和专家意见涉及需要ECMO的患者的机械通气特定管理，包括模式和呼吸机设置。通过详细检索PubMed、奥维德、科克伦数据库和Google Scholar识别文章。从选定的研究中检索了其他参考文献。越来越多的证据表明，ECMO患者的机械通气设置对于尽量减少进一步的肺损伤和改善预后非常重要。在ECMO治疗呼吸衰竭期间，超保护性通气策略可能是机械通气的最佳选择。在静脉动脉ECMO支持心力衰竭时，应考虑气道压力对右心室和左心室后负荷的影响。未来的研究需要更好地了解有创机械通气模式和设置对结局的潜在影响。
The timing of extracorporeal membrane oxygenation (ECMO) initiation and its outcome in the management of respiratory and cardiac failure have received considerable attention, but very little attention has been given to mechanical ventilation during ECMO. Mechanical ventilation settings in non-ECMO studies have been shown to have an effect on survival and may also have contributed to a treatment effect in ECMO trials. Protective lung ventilation strategies established for non-ECMO-supported respiratory failure patients may not be optimal for more severe forms of respiratory failure requiring ECMO support. The influence of positive end-expiratory pressure on the reduction of the left ventricular compliance may be a matter of concern for patients receiving ECMO support for cardiac failure. The objectives of this review were to describe potential mechanisms for lung injury during ECMO for respiratory or cardiac failure, to assess the possible benefits from the use of ultra-protective lung ventilation strategies and to review published guidelines and expert opinions available on mechanical ventilation-specific management of patients requiring ECMO, including mode and ventilator settings. Articles were identified through a detailed search of PubMed, Ovid, Cochrane databases and Google Scholar. Additional references were retrieved from the selected studies. Growing evidence suggests that mechanical ventilation settings are important in ECMO patients to minimize further lung damage and improve outcomes. An ultra-protective ventilation strategy may be optimal for mechanical ventilation during ECMO for respiratory failure. The effects of airway pressure on right and left ventricular afterload should be considered during venoarterial ECMO support of cardiac failure. Future studies are needed to better understand the potential impact of invasive mechanical ventilation modes and settings on outcomes.
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影响因子：
38.9
作者：
Bein, Thomas;Weber-Carstens, Steffen;Goldmann, Anton;Mueller, Thomas;Staudinger, Thomas;Brederlau, Joerg;Muellenbach, Ralf;Dembinski, Rolf;Graf, Bernhard M.;Wewalka, Marlene;Philipp, Alois;Wernecke, Klaus-Dieter;Lubnow, Matthias;Slutsky, Arthur S.
通讯作者：
Slutsky, Arthur S.
影响因子：
38.9
作者：
Gattinoni, L;Pesenti, A
通讯作者：
Pesenti, A
影响因子：
3.2
作者：
Bein, Thomas;Osborn, Eric;Graf, Bernhard M.
通讯作者：
Graf, Bernhard M.
DOI：
10.1164/ajrccm.164.9.2103121
发表时间：
2001-11-01
影响因子：
24.7
作者：
Gattinoni, L;Caironi, P;Goodman, LR
通讯作者：
Goodman, LR
影响因子：
158.5
作者：
Brodie, Daniel;Bacchetta, Matthew
通讯作者：
Bacchetta, Matthew