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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 >Central extracorporeal membrane oxygenation for refractory pediatric septic shock
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Central extracorporeal membrane oxygenation for refractory pediatric septic shock

机译：中央体外膜氧合治疗难治性小儿败血性休克

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Objective: To demonstrate positive outcome, to achieve higher flow rates, and to reverse shock more quickly by implementing central extracorporeal membrane oxygenation (ECMO) in children with refractory septic shock. Children hospitalized with sepsis have significant mortality rates. The development of shock is the most important risk factor for death. For children with septic shock refractory to all other forms of therapy, ECMO has been recommended but estimated survival is <50% and the best method of applying the technology is unknown. In recent years, our institutional practice has been to cannulate children with refractory septic shock directly through the chest (central, atrioaortic ECMO) to achieve higher blood flow rates.Design: Retrospective case series.Setting: Intensive care unit of a tertiary referral pediatric hospital.Patients: Twenty-three children with refractory septic shock who received central ECMO primarily as circulatory support. Interventions: Central ECMO.Measurements and Main Results: The primary outcome measure was survival to hospital discharge. Pre-ECMO circulatory andventilatory parameters, infecting organism, duration and complications of ECMO and length of hospital stay were also collected. Twenty-three patients (median: age, 6 yrs; weight, 20 kg) over a 9-yr period were included. All patients had microbiological evidence of infection, and meningococcemia was the most common diagnosis. Twenty-two (96%) patients had failure of at least three organ systems, and all patients received at least two inotropes with a mean inotrope score of 82.2 (sd, 115.6). Eight (35%) patients suffered cardiac arrest and required external cardiac massage before ECMO. Eighteen (78%) patients survived to be decannulated off ECMO, and 17 (74%) children survived to hospital discharge. Higher pre-ECMO arterial lactate levels were associated with increased mortality (11.7 mmol/L in nonsurvivors vs. 6.0 mmol/L in survivors, p = .007).Conclusions: Central ECMO seem...
机译：目的：通过顽固性败血性休克患儿实施中央体外膜氧合（ECMO）来证明积极的结果，实现更高的流量并更快地逆转休克。败血症住院的儿童死亡率很高。休克的发展是最重要的死亡危险因素。对于所有其他形式的治疗都无法治愈的败血性休克儿童，建议使用ECMO，但估计生存率<50％，应用该技术的最佳方法尚不清楚。近年来，我们的机构做法是直接通过胸部（中央，房室ECMO）给患有顽固性败血性休克的儿童插管，以达到更高的血流量设计：回顾性病例系列背景：三级转诊儿科医院的重症监护室患者：23例顽固性败血性休克患儿主要接受循环ECMO治疗。干预措施：中央ECMO。测量和主要结果：主要结果指标是出院生存率。还收集了ECMO前的循环和换气参数，感染生物，ECMO的持续时间和并发症以及住院时间。纳入了9名患者中的23名患者（中位年龄：6岁;体重20 kg）。所有患者均具有感染的微生物学证据，脑膜炎球菌血症是最常见的诊断。 22名患者（96％）的至少三个器官系统衰竭，并且所有患者均接受了至少两个正性肌力药物，平均正性肌力评分为82.2（sd，115.6）。八名（35％）患者在ECMO之前经历了心脏骤停并需要外部心脏按摩。有18名（78％）患者通过ECMO得以无烟气存活，另有17名（74％）儿童存活至医院出院。 ECMO前动脉血乳酸水平升高与死亡率增加相关（非幸存者为11.7 mmol / L，幸存者为6.0 mmol / L，p = .007）。结论：中央ECMO似乎...

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