{"title":"早期PaCO2和pH波动对接受VV ECMO的ARDS患者神经预后的影响：来自CSECLS登记处的回顾性队列研究","authors":"Xiaoli Chen, Jinquan Xie, Ya Wang, Zhongtao Du, Xinyi Luo, Zitao Zeng, Haixiu Xie, Jinxiang Ma, Zhangwei Liang, Yin Xi, Jie Zhang, Weibo Liang, Chenglong Li, Zhenting Liang, Jiao Li, Weiqun He, Xiaoqing Liu, Yimin Li, Xiaotong Hou, Yonghao Xu","doi":"10.1186/s13613-025-01570-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Neurological complications significantly contributed to mortality in patients with acute respiratory distress syndrome (ARDS) supported by venovenous extracorporeal membrane oxygenation (VV ECMO). Early fluctuations in arterial partial pressure of carbon dioxide (PaCO<sub>2</sub>) during ECMO initiation may have affected cerebral perfusion and increased the risk of brain injury. This study investigated the association between early changes in PaCO<sub>2</sub> and pH levels and subsequent neurological outcomes in patients with ARDS receiving VV ECMO.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from adult ARDS patients who underwent VV ECMO between January 2018 and December 2022, sourced from the Chinese Society of Extracorporeal Life Support (CSECLS) Registry. Patients were stratified into clusters based on absolute changes in PaCO<sub>2</sub> and pH using K-means clustering. Logistic regression models and restricted cubic splines were used to evaluate the associations between these clusters and the occurrence of neurological complications, adjusting for potential confounders.</p><p><strong>Results: </strong>Among 983 patients included, the incidence of neurological complications was 2.95%. Cluster 1, characterized by significant reductions in PaCO<sub>2</sub> (median: -50 mmHg, relative reduction: -58%), exhibited the highest rate of neurological complications (11.94%). Cluster 3, with substantial increases in pH and minimal reductions in PaCO<sub>2</sub>, showed a relatively lower rate of neurological complications (3.96%), suggesting that PaCO<sub>2</sub> fluctuations, rather than pH changes, were primarily associated with neurological complications.</p><p><strong>Conclusions: </strong>Excessive reductions in PaCO<sub>2</sub> during the early initiation of VV ECMO, rather than pH elevation, were associated with an increased risk of neurological complications in ARDS patients. Close monitoring and management of PaCO<sub>2</sub> during ECMO initiation may mitigate this risk.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"143"},"PeriodicalIF":5.5000,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463811/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of early PaCO<sub>2</sub> and pH fluctuations on neurological outcomes in ARDS patients receiving VV ECMO: a retrospective cohort study from the CSECLS registry.\",\"authors\":\"Xiaoli Chen, Jinquan Xie, Ya Wang, Zhongtao Du, Xinyi Luo, Zitao Zeng, Haixiu Xie, Jinxiang Ma, Zhangwei Liang, Yin Xi, Jie Zhang, Weibo Liang, Chenglong Li, Zhenting Liang, Jiao Li, Weiqun He, Xiaoqing Liu, Yimin Li, Xiaotong Hou, Yonghao Xu\",\"doi\":\"10.1186/s13613-025-01570-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Neurological complications significantly contributed to mortality in patients with acute respiratory distress syndrome (ARDS) supported by venovenous extracorporeal membrane oxygenation (VV ECMO). Early fluctuations in arterial partial pressure of carbon dioxide (PaCO<sub>2</sub>) during ECMO initiation may have affected cerebral perfusion and increased the risk of brain injury. This study investigated the association between early changes in PaCO<sub>2</sub> and pH levels and subsequent neurological outcomes in patients with ARDS receiving VV ECMO.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from adult ARDS patients who underwent VV ECMO between January 2018 and December 2022, sourced from the Chinese Society of Extracorporeal Life Support (CSECLS) Registry. Patients were stratified into clusters based on absolute changes in PaCO<sub>2</sub> and pH using K-means clustering. Logistic regression models and restricted cubic splines were used to evaluate the associations between these clusters and the occurrence of neurological complications, adjusting for potential confounders.</p><p><strong>Results: </strong>Among 983 patients included, the incidence of neurological complications was 2.95%. Cluster 1, characterized by significant reductions in PaCO<sub>2</sub> (median: -50 mmHg, relative reduction: -58%), exhibited the highest rate of neurological complications (11.94%). Cluster 3, with substantial increases in pH and minimal reductions in PaCO<sub>2</sub>, showed a relatively lower rate of neurological complications (3.96%), suggesting that PaCO<sub>2</sub> fluctuations, rather than pH changes, were primarily associated with neurological complications.</p><p><strong>Conclusions: </strong>Excessive reductions in PaCO<sub>2</sub> during the early initiation of VV ECMO, rather than pH elevation, were associated with an increased risk of neurological complications in ARDS patients. Close monitoring and management of PaCO<sub>2</sub> during ECMO initiation may mitigate this risk.</p>\",\"PeriodicalId\":7966,\"journal\":{\"name\":\"Annals of Intensive Care\",\"volume\":\"15 1\",\"pages\":\"143\"},\"PeriodicalIF\":5.5000,\"publicationDate\":\"2025-09-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463811/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Intensive Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13613-025-01570-9\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Intensive Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13613-025-01570-9","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Impact of early PaCO2 and pH fluctuations on neurological outcomes in ARDS patients receiving VV ECMO: a retrospective cohort study from the CSECLS registry.
Background: Neurological complications significantly contributed to mortality in patients with acute respiratory distress syndrome (ARDS) supported by venovenous extracorporeal membrane oxygenation (VV ECMO). Early fluctuations in arterial partial pressure of carbon dioxide (PaCO2) during ECMO initiation may have affected cerebral perfusion and increased the risk of brain injury. This study investigated the association between early changes in PaCO2 and pH levels and subsequent neurological outcomes in patients with ARDS receiving VV ECMO.
Methods: We conducted a retrospective cohort study using data from adult ARDS patients who underwent VV ECMO between January 2018 and December 2022, sourced from the Chinese Society of Extracorporeal Life Support (CSECLS) Registry. Patients were stratified into clusters based on absolute changes in PaCO2 and pH using K-means clustering. Logistic regression models and restricted cubic splines were used to evaluate the associations between these clusters and the occurrence of neurological complications, adjusting for potential confounders.
Results: Among 983 patients included, the incidence of neurological complications was 2.95%. Cluster 1, characterized by significant reductions in PaCO2 (median: -50 mmHg, relative reduction: -58%), exhibited the highest rate of neurological complications (11.94%). Cluster 3, with substantial increases in pH and minimal reductions in PaCO2, showed a relatively lower rate of neurological complications (3.96%), suggesting that PaCO2 fluctuations, rather than pH changes, were primarily associated with neurological complications.
Conclusions: Excessive reductions in PaCO2 during the early initiation of VV ECMO, rather than pH elevation, were associated with an increased risk of neurological complications in ARDS patients. Close monitoring and management of PaCO2 during ECMO initiation may mitigate this risk.
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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