体外膜肺氧合辅助下急性呼吸窘迫综合征俯卧位通气策略

Strategies of prone ventilation for acute respiratory stress syndrome assisted by extracorporeal membrane oxygenation

静脉-静脉体外膜肺氧合(veno-venous extracorporeal membrane oxygenation, VV-ECMO)可以改善难治性低氧血症和(或)高碳酸血症急性呼吸窘迫综合征(ARDS)患者气体交换,从而使肺“休息”,并降低呼吸机诱导的肺损伤,常用于重度ARDS抢救治疗。俯卧位(prone positioning, PP)可改善中重度ARDS患者氧合、降低病死率,并被指南所推荐。对于俯卧位在VV-ECMO辅助期间的临床研究相对较少,缺少相关经验,VV-ECMO辅助期间患者往往处于仰卧位(supine position, SP)。近年来,越来越多的证据表明VV-ECMO辅助期间俯卧位可改善重度ARDS患者氧合、清除二氧化碳及改善呼吸系统顺应性,且无重大不良事件。该文结合相关文献证据对VV-ECMO辅助期间应用俯卧位进行相关综述。

Veno-venous Extracorporeal membrane oxygenation(VV-ECMO) is commonly used in the treatment of severe ARDS. It improves gas exchange, “rests” the lungs, and reduces ventilator-induced lung injury in ARDS patients with refractory hypoxemia and/or hypercapnia. Prone positioning(PP) is recommended by the guidelines for improving oxygenation and reducing mortality in moderate-to-severe ARDS patients. Due to the lack of clinical research evidence and relevant experience associated with prone positioning during extracorporeal support, patients on VV-ECMO support have historically been managed in supine position. Recently, a number of studies have reported the feasibility of PP during VV-ECMO assistance, which is associated with an improvement of oxygenation, CO;clearance and respiratory system compliance. This paper reviews the research progress of PP application during VV-ECMO assistance by collecting relevant research evidence.