ARDS患者接受V-V ECMO是否还需俯卧位治疗

Is prone position still needed for ARDS patients receiving V-V ECMO

急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者出现难治性低氧血症和(或)高碳酸血症,以及无法实施保护性通气时,早期静脉-静脉体外膜肺氧合(veno-venous extracorporeal membrane oxygenation,V-V ECMO)被证实可改善患者临床结局。俯卧位可降低中重度ARDS患者的病死率,对气体交换、呼吸力学、血流动力学产生一定的影响,但在V-V ECMO时,这些生理影响变得更为复杂。如何在V-V ECMO时实施个体化俯卧位策略,包括俯卧位的适应证、时机、持续时间、频率、呼吸机设定和呼吸驱动的管理,未来仍需探索。

When refractory hypoxemia and(or)hypercapnia occur,and protective ventilation cannot be implemented in the patients with acute respiratory distress syndrome(ARDS),early veno-venous extracorporeal membrane oxygenation(V-V ECMO)has been confirmed to improve their clinical outcome.Prone position can reduce the mortality in patients with moderate to severe ARDS owing to its effects on gas exchange,respiratory mechanics,and hemodynamics;however,these physiological effects become more complicated during V-V ECMO.In the future,researchers will investigate how to adopt a personalized prone position strategy during V-V ECMO,including indications,timing,duration,frequency,ventilator setting,and respiratory drive management.