Lung Recruitability in Severe Acute Respiratory Distress Syndrome Requiring Extracorporeal Membrane Oxygenation

被引：32

作者：

Camporota, Luigi ^{[1
,2
]}

Caricola, Elena V. ^{[1
,2
,3
]}

Bartolomeo, Nicola ^{[4
]}

Di Mussi, Rossella ^{[3
]}

Wyncoll, Duncan L. A. ^{[1
,2
]}

Meadows, Christopher I. S. ^{[1
,2
]}

Amado-Rodriguez, Laura ^{[1
,2
,5
,6
,7
,8
]}

Vasques, Francesco ^{[1
,2
]}

Sanderson, Barnaby ^{[1
,2
]}

Glover, Guy W. ^{[1
,2
]}

Barrett, Nicholas A. ^{[1
,2
]}

Shankar-Hari, Manu ^{[1
,2
,9
]}

Grasso, Salvatore ^{[3
]}

机构：

[1] Guys & St Thomas NHS Fdn Trust, Dept Adult Crit Care, Kings Hlth Partners, London, England

[2] Kings Coll London, Div Ctr Human Appl Physiol Sci, London, England

[3] Univ Bari Aldo Moro, Dept Emergency & Organ Transplants DETO, Anesthesiol & Intens Care, Bari, Italy

[4] Univ Aldo Moro, Dept Biomed Sci & Human Oncol, Chair Med Stat, Bari, Italy

[5] Inst Invest Sanitaria Principado Asturias, Oviedo, Spain

[6] Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Resp, Madrid, Spain

[7] Univ Cent Hosp Asturias, Cardiac Crit Care Unit, Oviedo, Spain

[8] Univ Oviedo, Dept Funct Biol, Oviedo, Spain

[9] Kings Coll London, Sch Immunol & Microbial Sci, Peter Gorer Dept Immunobiol, London, England

来源：

CRITICAL CARE MEDICINE | 2019年 / 47卷 / 09期

基金：

美国国家卫生研究院;

关键词：

adult acute respiratory distress syndrome; extracorporeal membrane oxygenation; mechanical ventilation; recruitment; END-EXPIRATORY PRESSURE; PULMONARY-EDEMA; MECHANICAL VENTILATION; BERLIN DEFINITION; TIDAL VOLUME; CARE;

D O I：

10.1097/CCM.0000000000003837

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objectives: Quantification of potential for lung recruitment may guide the ventilatory strategy in acute respiratory distress syndrome. However, there are no quantitative data on recruitability in patients with severe acute respiratory distress syndrome who require extracorporeal membrane oxygenation. We sought to quantify potential for lung recruitment and its relationship with outcomes in this cohort of patients. Design: A single-center, retrospective, observational cohort study. Setting: Tertiary referral severe respiratory failure center in a university hospital in the United Kingdom. Patients: Forty-seven adults with severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. Intervention: None. Measurements and Main Results: In patients with severe acute respiratory distress syndrome-mainly of pulmonary origin (86%)-the potential for lung recruitment and the weight of nonaerated, poorly aerated, normally aerated, and hyperaerated lung tissue were assessed at low (5 cmH(2)O) and high (45 cmH(2)O) airway pressures. Patients were categorized as high or low potential for lung recruitment based on the median potential for lung recruitment value of the study population. The median potential for lung recruitment was 24.3% (interquartile range = 11.4-37%) ranging from -2% to 76.3% of the total lung weight. Patients with potential for lung recruitment above the median had significantly shorter extracorporeal membrane oxygenation duration (8 vs 13 d; p = 0.013) and shorter ICU stay (15 vs 22 d; p = 0.028), but mortality was not statistically different (24% vs 46%; p = 0.159). Conclusions: We observed significant variability in potential for lung recruitment in patients with severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. Patients with high potential for lung recruitment had a shorter ICU stay and shorter extracorporeal membrane oxygenation duration.

引用

页码：1177 / 1183

页数：7

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