Chest CT findings in severe acute respiratory distress syndrome requiring V-V ECMO: J-CARVE registry.

IF 3.8 2区医学 Q1 CRITICAL CARE MEDICINE

Journal of Intensive Care Pub Date : 2024-01-26 DOI:10.1186/s40560-023-00715-x

Mitsuaki Nishikimi, Shinichiro Ohshimo, Wataru Fukumoto, Jun Hamaguchi, Kazuki Matsumura, Kenji Fujizuka, Yoshihiro Hagiwara, Ryuichi Nakayama, Naofumi Bunya, Junichi Maruyama, Toshikazu Abe, Tatsuhiko Anzai, Yoshitaka Ogata, Hiromichi Naito, Yu Amemiya, Tokuji Ikeda, Masayuki Yagi, Yutaro Furukawa, Hayato Taniguchi, Tsukasa Yagi, Ken Katsuta, Daisuke Konno, Ginga Suzuki, Yuki Kawasaki, Noriyuki Hattori, Tomoyuki Nakamura, Natsuki Kondo, Hitoshi Kikuchi, Shinichi Kai, Saaya Ichiyama, Kazuo Awai, Kunihiko Takahashi, Nobuaki Shime

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引用次数: 0

Abstract

Background: Chest computed tomography findings are helpful for understanding the pathophysiology of severe acute respiratory distress syndrome (ARDS). However, there is no large, multicenter, chest computed tomography registry for patients requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO). The aim of this study was to describe chest computed tomography findings at V-V ECMO initiation and to evaluate the association between the findings and outcomes in severe ARDS.

Methods: This multicenter, retrospective cohort study enrolled patients with severe ARDS on V-V ECMO, who were admitted to the intensive care units of 24 hospitals in Japan between January 1, 2012, and December 31, 2022.

Results: The primary outcome was 90-day in-hospital mortality. The secondary outcomes were the successful liberation from V-V ECMO and the values of static lung compliance. Among the 697 registry patients, of the 582 patients who underwent chest computed tomography at V-V ECMO initiation, 394 survived and 188 died. Multivariate Cox regression showed that traction bronchiectasis and subcutaneous emphysema increased the risk of 90-day in-hospital mortality (hazard ratio [95% confidence interval] 1.77 [1.19-2.63], p = 0.005 and 1.97 [1.02-3.79], p = 0.044, respectively). The presence of traction bronchiectasis was also associated with decreased successful liberation from V-V ECMO (odds ratio: 0.27 [0.14-0.52], p < 0.001). Lower static lung compliance was associated with some chest computed tomography findings related to changes outside of pulmonary opacity, but not with the findings related to pulmonary opacity.

Conclusions: Traction bronchiectasis and subcutaneous emphysema increased the risk of 90-day in-hospital mortality in patients with severe ARDS who required V-V ECMO.

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需要 V-V ECMO 的严重急性呼吸窘迫综合征患者的胸部 CT 发现：J-CARVE 登记。

背景：胸部计算机断层扫描结果有助于了解严重急性呼吸窘迫综合征（ARDS）的病理生理学。然而，目前还没有针对需要静脉体外膜肺氧合（V-V ECMO）患者的大型多中心胸部计算机断层扫描登记。本研究旨在描述 V-V ECMO 启动时的胸部计算机断层扫描结果，并评估这些结果与重度 ARDS 患者预后之间的关联：这项多中心回顾性队列研究招募了在 2012 年 1 月 1 日至 2022 年 12 月 31 日期间入住日本 24 家医院重症监护病房、接受 V-V ECMO 的重度 ARDS 患者：主要结果是 90 天院内死亡率。次要结果是成功脱离 V-V ECMO 和静态肺顺应性值。在 697 名登记患者中，582 名患者在 V-V ECMO 启动时接受了胸部计算机断层扫描，其中 394 人存活，188 人死亡。多变量 Cox 回归显示，牵引性支气管扩张和皮下气肿增加了 90 天院内死亡的风险（危险比 [95% 置信区间] 分别为 1.77 [1.19-2.63]，p = 0.005 和 1.97 [1.02-3.79]，p = 0.044）。牵引性支气管扩张与成功脱离 V-V ECMO 的几率降低也有关系（几率比：0.27 [0.14-0.52]，P = 0.005）：牵引性支气管扩张和皮下气肿增加了需要 V-V ECMO 的重度 ARDS 患者 90 天院内死亡的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine

CiteScore

11.90

自引率

1.40%

发文量

审稿时长

15 weeks

期刊介绍： "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.