{"title":"驱动压力对严重ARDS患者ECMO启动和维持的预后意义：一项系统综述和meta分析。","authors":"Pratibha Todur, Anitha Nileshwar, Souvik Chaudhuri, Danavath Nagendra, Vishal Shanbhag, J Vennila","doi":"10.5005/jp-journals-10071-24893","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>In life-threatening conditions like severe acute respiratory distress syndrome (ARDS), rescue interventions like extracorporeal membrane oxygenation (ECMO) should be initiated urgently to resolve an otherwise potentially adverse clinical outcome. Driving pressure (DP) is an independent prognosticator of the survival of ARDS during mechanical ventilation. We conducted this review with the objective to identify the optimal DP for initiating ECMO in severe ARDS and to study the change in DP during ECMO strategy in survivors and non-survivors.</p><p><strong>Materials and methods: </strong>A systematic search of EMBASE, PubMed, Cochrane Library, and SCOPUS databases was conducted from their inception to January 2024. Two investigators independently carried out the processes of literature search, study selection, data extraction, and quality assessment. The analysis was conducted using comprehensive meta-analysis software (CMA).</p><p><strong>Results: </strong>For meta-analysis, six studies comprising 668 patients were included. In survivors, the DP at ECMO initiation was lower (mean DP = 14.56 cm H<sub>2</sub>O, 95% CI: [11.060-18.060]) than non-survivors (mean DP = 17.77 cm H<sub>2</sub>O, 95% CI: [12.935-22.607]). During ECMO, the survivors had lower DP (mean DP = 11.63 cm H<sub>2</sub>O, 95% CI: [10.070-13.195]) than non-survivors (mean DP = 14.67 cm H<sub>2</sub>O, 95% CI: [12.810-15.831]).</p><p><strong>Conclusion: </strong>The optimum DP to initiate ECMO in severe ARDS patients on MV is 15 cm H<sub>2</sub>O. Extracorporeal membrane oxygenation reduces the intensity of MV, as reflected by a reduction in DP in both survivors and non-survivors during the ECMO by 3 cm H<sub>2</sub>O. The DP ≤ 12 cm H<sub>2</sub>O during ECMO strategy is a predictor of survival, and DP persisting ≥ 15 cm H<sub>2</sub>O on ECMO prompts the search for strategies to reduce DP.</p><p><strong>Trial registration: </strong>PROSPERO CRD42022327846.</p><p><strong>How to cite this article: </strong>Todur P, Nileshwar A, Chaudhuri S, Nagendra D, Shanbhag V, Vennila J. Prognostic Significance of Driving Pressure for Initiation and Maintenance of ECMO in Patients with Severe ARDS: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2025;29(2):177-185.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 2","pages":"177-185"},"PeriodicalIF":1.5000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915431/pdf/","citationCount":"0","resultStr":"{\"title\":\"Prognostic Significance of Driving Pressure for Initiation and Maintenance of ECMO in Patients with Severe ARDS: A Systematic Review and Meta-analysis.\",\"authors\":\"Pratibha Todur, Anitha Nileshwar, Souvik Chaudhuri, Danavath Nagendra, Vishal Shanbhag, J Vennila\",\"doi\":\"10.5005/jp-journals-10071-24893\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>In life-threatening conditions like severe acute respiratory distress syndrome (ARDS), rescue interventions like extracorporeal membrane oxygenation (ECMO) should be initiated urgently to resolve an otherwise potentially adverse clinical outcome. Driving pressure (DP) is an independent prognosticator of the survival of ARDS during mechanical ventilation. We conducted this review with the objective to identify the optimal DP for initiating ECMO in severe ARDS and to study the change in DP during ECMO strategy in survivors and non-survivors.</p><p><strong>Materials and methods: </strong>A systematic search of EMBASE, PubMed, Cochrane Library, and SCOPUS databases was conducted from their inception to January 2024. Two investigators independently carried out the processes of literature search, study selection, data extraction, and quality assessment. The analysis was conducted using comprehensive meta-analysis software (CMA).</p><p><strong>Results: </strong>For meta-analysis, six studies comprising 668 patients were included. In survivors, the DP at ECMO initiation was lower (mean DP = 14.56 cm H<sub>2</sub>O, 95% CI: [11.060-18.060]) than non-survivors (mean DP = 17.77 cm H<sub>2</sub>O, 95% CI: [12.935-22.607]). During ECMO, the survivors had lower DP (mean DP = 11.63 cm H<sub>2</sub>O, 95% CI: [10.070-13.195]) than non-survivors (mean DP = 14.67 cm H<sub>2</sub>O, 95% CI: [12.810-15.831]).</p><p><strong>Conclusion: </strong>The optimum DP to initiate ECMO in severe ARDS patients on MV is 15 cm H<sub>2</sub>O. Extracorporeal membrane oxygenation reduces the intensity of MV, as reflected by a reduction in DP in both survivors and non-survivors during the ECMO by 3 cm H<sub>2</sub>O. The DP ≤ 12 cm H<sub>2</sub>O during ECMO strategy is a predictor of survival, and DP persisting ≥ 15 cm H<sub>2</sub>O on ECMO prompts the search for strategies to reduce DP.</p><p><strong>Trial registration: </strong>PROSPERO CRD42022327846.</p><p><strong>How to cite this article: </strong>Todur P, Nileshwar A, Chaudhuri S, Nagendra D, Shanbhag V, Vennila J. Prognostic Significance of Driving Pressure for Initiation and Maintenance of ECMO in Patients with Severe ARDS: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2025;29(2):177-185.</p>\",\"PeriodicalId\":47664,\"journal\":{\"name\":\"Indian Journal of Critical Care Medicine\",\"volume\":\"29 2\",\"pages\":\"177-185\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915431/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Indian Journal of Critical Care Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5005/jp-journals-10071-24893\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/31 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Critical Care Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5005/jp-journals-10071-24893","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/31 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
在危及生命的情况下，如严重急性呼吸窘迫综合征（ARDS），应紧急启动抢救干预措施，如体外膜氧合（ECMO），以解决其他潜在的不良临床结果。驱动压力（DP）是机械通气期间ARDS生存的独立预测指标。我们进行了这项综述，目的是确定严重ARDS患者启动ECMO的最佳DP，并研究幸存者和非幸存者在ECMO策略期间DP的变化。材料和方法：系统检索EMBASE、PubMed、Cochrane Library和SCOPUS数据库，检索时间从数据库建立到2024年1月。两位研究者独立进行文献检索、研究选择、数据提取和质量评估。采用综合元分析软件（CMA）进行分析。结果：meta分析纳入6项研究，668例患者。在幸存者中，ECMO开始时的DP（平均DP = 14.56 cm H2O, 95% CI:[11.060-18.060]）低于非幸存者（平均DP = 17.77 cm H2O, 95% CI:[12.935-22.607]）。在ECMO期间，幸存者的DP（平均DP = 11.63 cm H2O, 95% CI:[10.070-13.195]）低于非幸存者（平均DP = 14.67 cm H2O, 95% CI:[12.810-15.831]）。结论：重症ARDS患者启动ECMO的最佳时间点为15cm H2O。体外膜氧合降低了MV强度，这反映在ECMO期间幸存者和非幸存者的DP降低了3cm H2O。ECMO策略期间DP≤12 cm H2O是生存的预测因子，而在ECMO中DP持续≥15 cm H2O促使寻求降低DP的策略。试验注册：PROSPERO CRD42022327846。Todur P, Nileshwar A, Chaudhuri S, Nagendra D, Shanbhag V, Vennila J.驱动压力对严重急性呼吸窘迫综合征患者ECMO启动和维持的预后意义：系统回顾和meta分析。中华检验医学杂志，2015;29(2):177-185。
Prognostic Significance of Driving Pressure for Initiation and Maintenance of ECMO in Patients with Severe ARDS: A Systematic Review and Meta-analysis.
Introduction: In life-threatening conditions like severe acute respiratory distress syndrome (ARDS), rescue interventions like extracorporeal membrane oxygenation (ECMO) should be initiated urgently to resolve an otherwise potentially adverse clinical outcome. Driving pressure (DP) is an independent prognosticator of the survival of ARDS during mechanical ventilation. We conducted this review with the objective to identify the optimal DP for initiating ECMO in severe ARDS and to study the change in DP during ECMO strategy in survivors and non-survivors.
Materials and methods: A systematic search of EMBASE, PubMed, Cochrane Library, and SCOPUS databases was conducted from their inception to January 2024. Two investigators independently carried out the processes of literature search, study selection, data extraction, and quality assessment. The analysis was conducted using comprehensive meta-analysis software (CMA).
Results: For meta-analysis, six studies comprising 668 patients were included. In survivors, the DP at ECMO initiation was lower (mean DP = 14.56 cm H2O, 95% CI: [11.060-18.060]) than non-survivors (mean DP = 17.77 cm H2O, 95% CI: [12.935-22.607]). During ECMO, the survivors had lower DP (mean DP = 11.63 cm H2O, 95% CI: [10.070-13.195]) than non-survivors (mean DP = 14.67 cm H2O, 95% CI: [12.810-15.831]).
Conclusion: The optimum DP to initiate ECMO in severe ARDS patients on MV is 15 cm H2O. Extracorporeal membrane oxygenation reduces the intensity of MV, as reflected by a reduction in DP in both survivors and non-survivors during the ECMO by 3 cm H2O. The DP ≤ 12 cm H2O during ECMO strategy is a predictor of survival, and DP persisting ≥ 15 cm H2O on ECMO prompts the search for strategies to reduce DP.
Trial registration: PROSPERO CRD42022327846.
How to cite this article: Todur P, Nileshwar A, Chaudhuri S, Nagendra D, Shanbhag V, Vennila J. Prognostic Significance of Driving Pressure for Initiation and Maintenance of ECMO in Patients with Severe ARDS: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2025;29(2):177-185.
期刊介绍：
Indian Journal of Critical Care Medicine (ISSN 0972-5229) is specialty periodical published under the auspices of Indian Society of Critical Care Medicine. Journal encourages research, education and dissemination of knowledge in the fields of critical and emergency medicine.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
