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首页> 外文期刊>Artificial Organs >Restrictive Transfusion Practice During Extracorporeal Membrane Oxygenation Therapy for Severe Acute Respiratory Distress Syndrome
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Restrictive Transfusion Practice During Extracorporeal Membrane Oxygenation Therapy for Severe Acute Respiratory Distress Syndrome

机译：严重急性呼吸窘迫综合征的体外膜氧合治疗期间的限制性输血实践

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Recommendations concerning the management of hemoglobin levels and hematocrit in patients on extracorporeal membrane oxygenation (ECMO) still advise maintenance of a normal hematocrit. In contrast, current transfusion guidelines for critically ill patients support restrictive transfusion practice. We report on a series of patients receiving venovenous ECMO (vvECMO) for acute respiratory distress syndrome (ARDS) treated according to the restrictive transfusion regimen recommended for critically ill patients. We retrospectively analyzed 18 patients receiving vvECMO due to severe ARDS. Hemoglobin concentrations were kept between 7 and 9 g/dL with a transfusion trigger at 7 g/dL or when physiological transfusion triggers were apparent. We assessed baseline data, hospital mortality, time on ECMO, hemoglobin levels, hematocrit, quantities of packed red blood cells received, and lactate concentrations and compared survivors and nonsurvivors. The overall mortality of all patients on vvECMO was 38.9%. Mean hemoglobin concentration over all patients and ECMO days was 8.30 +/- 0.51 g/dL, and hematocrit was 0.25 +/- 0.01, with no difference between survivors and nonsurvivors. Mean numbers of given PRBCs showed a trend towards higher quantities in the group of nonsurvivors, but the difference was not significant (1.97 +/- 1.47 vs. 0.96 +/- 0.76 units; P = 0.07). Mean lactate clearance from the first to the third day was 45.4 +/- 28.3%, with no significant difference between survivors and nonsurvivors (P = 0.19). In our cohort of patients treated with ECMO due to severe ARDS, the application of a restrictive transfusion protocol did not result in an increased mortality. Safety and feasibility of the application of a restrictive transfusion protocol in patients on ECMO must further be evaluated in randomized controlled trials.
机译：关于体外膜氧合（ECMO）患者血红蛋白水平和血细胞比容管理的建议仍建议维持正常的血细胞比容。相反，当前针对重症患者的输血指南支持限制性输血实践。我们报告了一系列针对急性呼吸窘迫综合征（ARDS）接受静脉静脉ECMO（vvECMO）的患者，并根据重症患者的限制性输注方案进行了治疗。我们回顾性分析了18例因严重ARDS而接受vvECMO的患者。血红蛋白浓度保持在7到9 g / dL之间，输血触发条件为7 g / dL或出现明显的生理输血触发条件时。我们评估了基线数据，医院死亡率，ECMO时间，血红蛋白水平，血细胞比容，接收到的堆积红细胞数量以及乳酸浓度，并对幸存者和非幸存者进行了比较。使用vvECMO的所有患者的总死亡率为38.9％。在所有患者和ECMO天中，平均血红蛋白浓度为8.30 +/- 0.51 g / dL，血细胞比容为0.25 +/- 0.01，幸存者和非幸存者之间无差异。非幸存者组中给定PRBC的平均数量呈增加趋势，但差异并不显着（1.97 +/- 1.47与0.96 +/- 0.76单位; P = 0.07）。从第一天到第三天的平均乳酸清除率为45.4 +/- 28.3％，幸存者和非幸存者之间无显着差异（P = 0.19）。在我们的因严重ARDS而接受ECMO治疗的患者队列中，应用限制性输注方案并未导致死亡率增加。在ECMO患者中应用限制性输注方案的安全性和可行性必须在随机对照试验中进一步评估。

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