静脉‑静脉体外膜肺氧合上机时机的探讨

Timing of starting veno‑venous extracorporeal membrane oxygenation

静脉-静脉体外膜肺氧合(VV-ECMO)目前主要用于常规措施难以纠正的急性呼吸衰竭,且这种导致呼吸衰竭的病因是可逆的,或是为肺移植提供桥接手段。急性呼吸窘迫综合征(ARDS)是急性呼吸衰竭中的典型的临床综合征。重症ARDS患者VV-ECMO上机的时机仍面临诸多的争议和挑战,本文从机械通气参数优化、呼吸动力学及血流动力学监测、肺可复张性评估以及电阻抗成像(EIT)实时监测等方面,对目前可行的上机前评估手段进行汇总探讨。

Veno-venous extracorporeal membrane oxygenation(VV-ECMO)is mainly used for reversible acute respiratory failure that is difficult to correct with mechanical ventilation and other conventional measures or preparation of lung transplantation.Acute respiratory distress syndrome(ARDS)is a typical clinical syndrome of acute respiratory failure.The timing of starting VV-ECMO in severe ARDS still face many controversies and challenges.This paper we discuss the current feasible assessment methods of when to start VV-ECMO in ARDS,such as,optimization of mechanical ventilation parameters,monitoring of respiratory dynamics and hemodynamics,assessment of lung recruitability and electrical impedance tomography(EIT)real-time monitoring,etc.