Fever following extracorporeal membrane oxygenation decannulation: Infection, thrombosis or just physiology?

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2024-11-11 DOI:10.1016/j.jcrc.2024.154945

Benjamin Assouline , Gianlucca Belli , Karim Dorgham , Quentin Moyon , Alexandre Coppens , Marc Pineton de Chambrun , Juliette Chommeloux , David Levy , Ouriel Saura , Guillaume Hekimian , Matthieu Schmidt , Alain Combes , Charles-Edouard Luyt

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Abstract

Purpose

Fever is frequent after extracorporeal membrane oxygenation (ECMO) decannulation. We aimed to evaluate the incidence of post-decannulation fever and describe its causes.

Methods

Adult ECMO patients who were successfully weaned from ECMO were retrospectively included. Minimal and maximal core temperatures were collected daily for each patient from 48 h before decannulation up to 5 days after. Patients were grouped according to the cause of fever (infection, thrombosis, or no evident cause) and compared. Plasma cytokine profile was obtained, each day from decannulation to 5 days after for 20 patients.

Results

Between January 2021 and December 2022, 123 patients successfully weaned from ECMO were included. Post-decannulation fever occurred in 54 patients (44 %). It was associated with an infection in 39 patients (72 %) and with a thrombosis in 6 patients (11 %), and no cause was identified in the remaining 9 (17 %). Prolonged ECMO duration, extended ICU length-of-stay, diabetes and vascular comorbidities were significantly associated with a higher risk of infection. Finally, the pro-inflammatory cytokine profiles did not differ between febrile and afebrile patients.

Conclusion

Post-decannulation fever was common, and was mainly due to infections or thrombosis. Fever should therefore not be considered as a benign inflammatory reaction until proven otherwise.

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体外膜肺氧合拔管后发热：感染、血栓还是生理学原因？

目的：体外膜肺氧合（ECMO）拔管后经常出现发热。我们旨在评估拔管后发热的发生率，并描述其原因：方法：我们回顾性地纳入了成功从 ECMO 断流的成年 ECMO 患者。从拔管前 48 小时到拔管后 5 天，每天收集每位患者的最低和最高体温。根据发热原因（感染、血栓或无明显原因）将患者分组并进行比较。从拔管到拔管后 5 天，每天采集 20 名患者的血浆细胞因子谱：结果：2021 年 1 月至 2022 年 12 月期间，共有 123 名患者成功脱离 ECMO。有 54 名患者（44%）在拔管后出现发热。39 名患者（72%）发热与感染有关，6 名患者（11%）发热与血栓形成有关，其余 9 名患者（17%）发热原因不明。延长 ECMO 持续时间、延长重症监护室的住院时间、糖尿病和血管并发症与较高的感染风险明显相关。最后，发热患者与无发热患者的促炎细胞因子谱无差异：结论：解痉后发热很常见，主要是由于感染或血栓形成。因此，在未证实之前，发热不应被视为良性炎症反应。

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 critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.