Lung Compliance and Outcomes in Patients With Acute Respiratory Distress Syndrome Receiving ECMO.

Autor:	Kim HS; Department of Cardiothoracic Surgery, Hallym University Sacred Heart Hospital, Anyang, South Korea., Kim JH; Department of Pulmonary, Allergy and Critical Care Medicine, CHA Bundang Medical Center, Seongnam, South Korea., Chung CR; Department of Critical Care Medicine, Samsung Medical Center, Seoul, South Korea., Hong SB; Department of Pulmonary and Critical Care Medicine, Asan Medical Center, Seoul, South Korea., Cho WH; Department of Pulmonary, Allergy and Critical Care Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea., Cho YJ; Department of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea., Sim YS; Department of Pulmonary and Critical Care Medicine, Kangnam Sacred Heart Hospital, Seoul, South Korea., Kim WY; Department of Pulmonary, Allergy and Critical Care Medicine, Pusan National University Hospital, Busan, South Korea., Kang BJ; Department of Internal Medicine, Ulsan University Hospital, Ulsan, South Korea., Park SH; Department of Pulmonary and Critical Care Medicine, Kangdong Kyung Hee University Hospital, Seoul, South Korea., Oh JY; Department of Pulmonology and Critical Care Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea., Park S; Department of Pulmonary and Critical Care Medicine, Chonbuk National University Hospital, Jeonju, South Korea., Park S; Department of Pulmonary and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea. Electronic address: f2000tj@gmail.com.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2019 Jul; Vol. 108 (1), pp. 176-182. Date of Electronic Publication: 2019 Mar 02.
DOI:	10.1016/j.athoracsur.2019.01.055
Abstrakt:	Background: Limited data are available regarding mechanical ventilation strategies in patients with acute respiratory distress syndrome receiving extracorporeal membrane oxygenation (ECMO). Methods: A retrospective analysis of acute respiratory distress syndrome patients on ECMO was conducted in 9 hospitals in Korea. Data on ventilator settings (pre-ECMO and 0, 4, 24, and 48 hours after ECMO) were collected. Based on the effect of the duration and intensity of mechanical ventilator on outcomes, time-weighted average values were calculated for ventilator parameters. Results: The 56 patients included in the study had a mean age of 55.5 years. The hospital and 6-month mortality rates were 48.1% and 54.0%, respectively, with a median ECMO duration of 9.4 days. After initiation of ECMO, peak inspiratory pressure, above positive end-expiratory pressure, tidal volume, and respiration rate were reduced, while lung compliance did not change significantly. Before and during ECMO support, tidal volume and lung compliance were higher in 6-month survivors than in nonsurvivors. In Cox proportional models, both lung compliance (odds ratio, 0.961; 95% confidence interval, 0.928 to 0.995) and time-weighted average-lung compliance (odds ratio, 0.943; 95% confidence interval, 0.903 to 0.986) were significantly associated with 6-month mortality. Kaplan-Meier curves revealed that patients with higher lung compliance before ECMO had a longer survival time at the 6-month follow-up than did those with lower lung compliance. Conclusions: Lung compliance, whether before or during ECMO, may be an important predictor of outcome in acute respiratory distress syndrome patients receiving ECMO. However, this result requires confirmation in larger clinical studies. (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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