High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation
High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation
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DOI：
10.1007/s001340050418
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发表时间：
1997-08-01
影响因子：
38.9
通讯作者：
Falke, KJ
中科院分区：
文献类型：
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作者：
Lewandowski, K;Rossaint, R;Falke, KJ
目的：探讨临床治疗方案能否改善急性呼吸窘迫综合征（ARDS）患者的低生存率。设计：无对照前瞻性试验。单位：一所大学附属医院重症监护室。患者和参与者：122例ARDS患者，连续入住ICU。干预措施：根据标准定义的临床算法治疗ARDS。该算法区分了两个主要治疗组：at -sin -ECMO（无体外膜氧合的高级治疗）组（n = 73）接受由一组高级无创治疗方案组成的治疗，ECMO治疗组（n = 49）接受使用肝素包被系统的额外体外膜氧合（ECMO）。测量和结果：两组在APACHE II （16 +/- 5 vs 18 +/- 5分，p = 0.01）和Murray评分（3.2 +/- 0.3 vs 3.4 +/- 0.3分，p = 0.0001）、入院前机械通气持续时间（10 +/- 9 vs 13 +/- 9天，p = 0.0151）和柏林ICU住院时间（31 +/- 17 vs 50 +/- 36天，p = 0.0016）方面均存在差异。at - sinecmo患者的初始PaO2/FIO2为86 +/- 27 mm Hg，在ICU第1天改善至165 +/- 107 mm Hg，而ECMO患者的初始PaO2/FIO2为67 +/- 28 mm Hg，直到ICU第13天才改善至160 +/- 102 mm Hg。ecmo治疗组的Qs/Q(T)明显高于对照组，在ICU的前14天超过50%。122例ARDS患者的总生存率为75%。AT-sine ECMO组和ECMO治疗组的生存率分别为89%和55% （p = 0.0000）。结论：采用临床算法可成功治疗ARDS患者，获得较高的生存率。
Objective: We investigated whether a treatment according to a clinical algorithm could improve the low survival rates in acute respiratory distress syndrome (ARDS).Design: Uncontrolled prospective trial.Setting: One university hospital intensive care department.Patients and participants: 122 patients with ARDS, consecutively admitted to the ICU.Interventions: ARDS was treated according to a criteria-defined clinical algorithm. The algorithm distinguished two main treatment groups: The AT-sine-ECMO (advanced treatment without extracorporeal membrane oxygenation) group (n = 73) received a treatment consisting of a set of advanced non-invasive treatment options, the ECMO treatment group (n = 49) received additional extracorporeal membrane oxygenation (ECMO) using heparin-coated systems.Measurements and results: The groups differed in both APACHE II (16 +/- 5 vs 18 +/- 5 points, p = 0.01) and Murray scores (3.2 +/- 0.3 vs 3.4 +/- 0.3 points, p = 0.0001), the duration of mechanical ventilation prior to admission (10 +/- 9 vs 13 +/- 9 days, p = 0.0151), and length of ICU stay in Berlin (31 +/- 17 vs 50 +/- 36 days, p = 0.0016). Initial PaO2/FIO2 was 86 +/- 27 mm Hg in AT-sine-ECMO patients that improved to 165 +/- 107 mm Hg on ICU day 1, while ECMO patients showed an initial PaO2/FIO2 of 67 +/- 28 mm Hg and improvement to 160 +/- 102 mm Hg was not reached until ICU day 13. Qs/Q(T) was significantly higher in the ECMO-treated group and exceeded 50 % during the first 14 ICU days. The overall survival rate in our 122 ARDS patients was 75 %. Survival rates were 89 % in the AT-sine ECMO group and 55 % in the ECMO treatment group (p = 0.0000).Conclusions: We conclude that patients with ARDS can be successfully treated with the clinical algorithm and high survival rates can be achieved.