High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation

被引:199
作者
Lewandowski, K
Rossaint, R
Pappert, D
Gerlach, H
Slama, KJ
Weidemann, H
Frey, DJM
Hoffmann, O
Keske, U
Falke, KJ
机构
[1] KRANKENHAUS SPANDAU, ABT ANASTHESIOL & OPERAT INTENS MED, D-13578 BERLIN, GERMANY
[2] HUMBOLDT UNIV BERLIN, KLIN ALLGEMEINCHIRURG & TRANSPLANTAT CHIRURG, KLINIKUM RUDOLF VIRCHOW, D-13353 BERLIN, GERMANY
[3] KRANKENHAUS BERLIN ZEHLENDORF, ABT THORAXCHIRURG, KLIN HECKESHORN, D-14109 BERLIN, GERMANY
[4] HUMBOLDT UNIV BERLIN, STRAHLENKLIN & POLIKLIN, KLINIKUM RUDOLF VIRCHOW, FAK MED, D-13353 BERLIN, GERMANY
关键词
acute respiratory distress syndrome (ARDS); extracorporeal membrane oxygenation (ECMO); mechanical ventilation; survival rates; clinical algorithm;
D O I
10.1007/s001340050418
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
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.
引用
收藏
页码:819 / 835
页数:17
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