ARDS患者V-V ECMO支持期间机械通气设置的研究

doi:10.3877/cma.j.issn.2096-1537.2022.04.017

保护性机械通气明显提高了急性呼吸窘迫综合征（ARDS）患者的生存率，但重度ARDS患者病死率仍较高，常需采用静脉-静脉体外膜肺氧合（V-V ECMO）进行呼吸支持。目前V-V ECMO期间的机械通气设置仍不明确，基于现有V-V ECMO支持期间机械通气的研究，被认可的是肺休息策略或超保护性机械通气策略：限制潮气量（Vt）≤4 ml/kg预测体质量（PBW），限制平台压≤25 cmH₂O（1 cmH₂O=0.098 kPa）并使用较高呼气末正压（PEEP）（≥10 cmH₂O），且在V-V ECMO支持期间进行密切的呼吸功能监测。本文描述ARDS患者在V-V ECMO支持期间的病理生理变化，并根据现有证据和文献报告，阐述机械通气策略、呼吸机参数设置以及呼吸功能监测方法。

关键词: 急性呼吸窘迫综合征, 静脉-静脉体外膜肺氧合, 机械通气

The mortality rate of patients with severe ARDS is still high, even with the protective mechanical ventilation. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) may be needed for better respiratory support. The settings of mechanical ventilation with ECMO are still unclear. Based on the existing studies, lung rest strategy or ultra-protective mechanical ventilation strategy are widely accepted: tidal volume (Vt) ≤4 ml/kg predicted body weight (PBW), plateau pressure ≤25 cmH₂O (1 cmH₂O=0.098 kPa) and positive end expiratory pressure (PEEP) ≥10 cmH₂O. And respiratory function should be monitored closely during V-V ECMO support. This paper describes the pathophysiological changes in ARDS patients during V-V ECMO and describes the mechanical ventilation strategy, ventilator parameter settings, and respiratory function monitoring methods based on the available evidence and reports in the literature.

Key words: Acute respiratory distress syndrome, Veno-venous extracorporeal membrane oxygenation, Mechanical ventilation

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Settings of mechanical ventilation during V-V ECMO support in ARDS patients

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Settings of mechanical ventilation during V-V ECMO support in ARDS patients