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首页> 外文期刊>Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies >Primary use of the venovenous approach for extracorporeal membrane oxygenation in pediatric acute respiratory failure.
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Primary use of the venovenous approach for extracorporeal membrane oxygenation in pediatric acute respiratory failure.

机译：小儿急性呼吸衰竭的体外膜氧合作用静脉方法的主要用途。

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OBJECTIVES: To describe a single center's experience with the primary use of venovenous cannulation for supporting pediatric acute respiratory failure patients with extracorporeal membrane oxygenation (ECMO). DESIGN: Retrospective chart review of all patients receiving extracorporeal life support at a single institution. SETTING: Pediatric intensive care unit at a tertiary care children's hospital. PATIENTS: Eighty-two patients between the ages of 2 wks and 18 yrs with severe acute respiratory failure. INTERVENTIONS: ECMO for acute respiratory failure. MEASUREMENTS AND MAIN RESULTS: From January 1991 until April 2002, 82 pediatric patients with acute respiratory failure were cannulated for ECMO support. Median duration of ventilation before ECMO was 5 days (range, 1-17 days). Sixty-eight of these patients (82%) initially were placed on venovenous ECMO. Fourteen patients were initiated and remained on venoarterial support, including six in whom venovenous cannulae could not be placed. One patient was converted from venovenous to venoarterial support due to inadequate oxygenation. Venoarterial patients had significantly greater alveolar-arterial oxygen gradients and lower PaO(2)/FIO(2) ratios than venovenous patients (p <.03). Fifty-five of 81 venovenous patients received additional drainage cannulae (46 of 55 with an internal jugular cephalad catheter). Thirty-five percent of venovenous patients and 36% of venoarterial patients required at least one vasopressor infusion at time of cannulation (p = nonsignificant); vasopressor dependence decreased over the course of ECMO in both groups. Median duration on venovenous ECMO for acute hypoxemic respiratory failure was 218 hrs (range, 24-921). Venovenous ECMO survivors remained cannulated for significantly shorter time than nonsurvivors did (median, 212 vs. 350 hrs; p =.04). Sixty-three of 82 ECMO (77%) patients survived to discharge-56 of 68 venovenous ECMO (81%) and nine of 14 venoarterial ECMO (64%). CONCLUSIONS: Venovenous ECMO can effectively provide adequate oxygenation for pediatric patients with severe acute respiratory failure receiving ECMO support. Additional cannulae placed at the initiation of venovenous ECMO could be beneficial in achieving flow rates necessary for adequate oxygenation and lung rest.
机译：目的：描述单个中心主要使用静脉插管支持小儿急性呼吸衰竭患者体外膜氧合（ECMO）的经验。设计：回顾性图表审查所有在一家机构接受体外生命支持的患者。地点：三级护理儿童医院的儿科重症监护室。患者：2周至18岁之间的82例严重急性呼吸衰竭患者。干预措施：ECMO用于急性呼吸衰竭。测量和主要结果：从1991年1月到2002年4月，为82例急性呼吸衰竭的小儿患者插管以接受ECMO支持。 ECMO前通气的中位时间为5天（范围1-17天）。这些患者中有68名（82％）最初被放置在静脉ECMO上。发起了14例患者并继续接受静脉动脉支持，其中6例患者无法放置静脉插管。由于氧合不足，一名患者从静脉静脉转换为静脉动脉支持。与静脉静脉患者相比，静脉动脉患者的肺泡动脉氧梯度明显更高，PaO（2）/ FIO（2）比率也更低（p <.03）。 81名静脉患者中有55名接受了额外的引流套管（55例中有46例带有颈内头颅导管）。 35％的静脉静脉患者和36％的静脉动脉患者在插管时需要至少输注一次血管加压药（p =无意义）;在两组中，在ECMO过程中，降压药依赖性均降低。急性低氧血症性呼吸衰竭的静脉ECMO持续时间中位数为218小时（范围24-921）。静脉ECMO幸存者保持插管的时间比非幸存者显着更短（中位数，212 vs. 350小时; p = .04）。 82名ECMO患者中有63名（77％）存活至出院，其中68名静脉静脉ECMO（81％）和14名静脉动脉ECMO中的9名（64％）。结论：静脉ECMO可以为患有ECMO支持的严重急性呼吸衰竭的小儿患者有效地提供充足的氧气。在静脉ECMO开始时放置额外的插管可能有利于获得足够的充氧和肺部休息所需的流速。

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