关于 ECCO2R 治疗急性低氧性呼吸衰竭的专家观点:2022 年欧洲圆桌会议的共识。

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE
Alain Combes, Georg Auzinger, Luigi Camporota, Gilles Capellier, Guglielmo Consales, Antonio Gomis Couto, Wojciech Dabrowski, Roger Davies, Oktay Demirkiran, Carolina Ferrer Gómez, Jutta Franz, Matthias Peter Hilty, David Pestaña, Nikoletta Rovina, Redmond Tully, Franco Turani, Joerg Kurz, Kai Harenski
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引用次数: 0

摘要

背景:通过控制高碳酸血症、呼吸性酸中毒及相关后果,体外二氧化碳清除(ECCO2R)有可能促进超保护肺通气(UPLV)策略并减少机械通气造成的损伤。我们召开了一次欧洲重症医学专家和肾脏病学专家会议,并采用改良的德尔菲流程对 ECCO2R 在急性呼吸窘迫综合征(ARDS)中的作用提供了最新见解,并为未来的随机对照试验提出了建议:专家组一致认为,肺保护性通气和 UPLV 应有不同的定义,UPLV 的主要定义是潮气量 (VT) 为 4-6 mL/kg(预测体重),驱动压力 (ΔP) ≤ 14-15 cmH2O。14 名与会者(93%)同意,大多数患者需要使用 ECCO2R 来实施 UPLV。此外,10 位与会者(多数,63%)将选择 PaO2:FiO2 > 100 mmHg(> 13.3 kPa)的患者,14 位与会者(一致,88%)将选择通气比 > 2.5-3 的患者。 有与会者(11/14 位与会者,79%)建议使用插入右颈内静脉的双腔短导管作为首选血管通路,通过持续肾脏支持机提供最低 80 mL/min 的二氧化碳去除率。14/15(93%,共识)名参与者表示,需要对 ARDS 患者进行新的 ECCO2R 随机试验。12/14 名参与者(86%)建议将ΔP ≥ 14-15 cmH2O 作为主要纳入标准:结论:ECCO2R 可在控制呼吸性酸中毒的同时,以较低的呼吸机容量和压力促进 UPLV。由于欧洲重症医学会最近的 ARDS 指南建议在随机对照试验之外不要使用 ECCO2R 治疗 ARDS,因此急需进行新的 ECCO2R 试验,建议将 ΔP ≥ 14-15 cmH2O 作为主要纳入标准。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Expert perspectives on ECCO<sub>2</sub>R for acute hypoxemic respiratory failure: consensus of a 2022 European roundtable meeting.

Expert perspectives on ECCO2R for acute hypoxemic respiratory failure: consensus of a 2022 European roundtable meeting.

Background: By controlling hypercapnia, respiratory acidosis, and associated consequences, extracorporeal CO2 removal (ECCO2R) has the potential to facilitate ultra-protective lung ventilation (UPLV) strategies and to decrease injury from mechanical ventilation. We convened a meeting of European intensivists and nephrologists and used a modified Delphi process to provide updated insights into the role of ECCO2R in acute respiratory distress syndrome (ARDS) and to identify recommendations for a future randomized controlled trial.

Results: The group agreed that lung protective ventilation and UPLV should have distinct definitions, with UPLV primarily defined by a tidal volume (VT) of 4-6 mL/kg predicted body weight with a driving pressure (ΔP) ≤ 14-15 cmH2O. Fourteen (93%) participants agreed that ECCO2R would be needed in the majority of patients to implement UPLV. Furthermore, 10 participants (majority, 63%) would select patients with PaO2:FiO2 > 100 mmHg (> 13.3 kPa) and 14 (consensus, 88%) would select patients with a ventilatory ratio of > 2.5-3. A minimum CO2 removal rate of 80 mL/min delivered by continuous renal support machines was suggested (11/14 participants, 79%) for this objective, using a short, double-lumen catheter inserted into the right internal jugular vein as the preferred vascular access. Of the participants, 14/15 (93%, consensus) stated that a new randomized trial of ECCO2R is needed in patients with ARDS. A ΔP of ≥ 14-15 cmH2O was suggested by 12/14 participants (86%) as the primary inclusion criterion.

Conclusions: ECCO2R may facilitate UPLV with lower volume and pressures provided by the ventilator, while controlling respiratory acidosis. Since recent European Society of Intensive Care Medicine guidelines on ARDS recommended against the use of ECCO2R for the treatment of ARDS outside of randomized controlled trials, new trials of ECCO2R are urgently needed, with a ΔP of ≥ 14-15 cmH2O suggested as the primary inclusion criterion.

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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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