The Effect of Extracorporeal Membrane Oxygenation Treatment on Patients with Severe Acute Respiratory Distress Syndrome Caused by Influenza Virus

流感病毒性肺炎引起嚴重急性呼吸窘迫症候群病患使用體外循環維生系統支持治療之效果

陳彥廷(Yen-Tin Chen) ； 許健威(Chien-Wei Hsu) ； 吳冠陞(Guan-Sheng Wu) ； 賴瑞生(Ruay-Sheng Lai)

《胸腔醫學》 28卷4期 (2013/08) Pp. 200-208

摘要

Objectives: We compared the clinical outcomes of patients with virus pneumonia and severe acute respiratory distress syndrome (ARDS) status treated with or without extracorporeal membrane oxygenation (ECMO) support.Methods: We retrospectively reviewed the hospital courses of patients who were admitted to intensive care unit (ICU) with severe ARDS (PaO2/FiO2 ＜100 under positive end expiratory pressure ＞5 cmH2O) due to influenza virus pneumonia and who had a period ≤7 days between the onset of influenza and intubation from January 2008 to December 2011. Clinical characteristics and outcomes were compared between patients with and without ECMO support.Results: A total of 13 patients with refractory hypoxemia and severe ARDS status were enrolled. Eleven of the 13 patients had a diagnosis of influenza confirmed by PCR test (8 influenza A (swH1), 2 influenza A (H3) and 1 influenza B), 1 by the influenza rapid test (influenza A) and 1 by bronchoalveolar lavage (BAL) virus isolation (influenza A). Six patients were provided with veno-venous ECMO (vv-ECMO) support and 7 patients received only conventional ventilatory support. Patients who were provided with ECMO support had a higher successful ventilator weaning rate (83.3% vs. 29%, p=0.048) than patients without ECMO support. The hospital mortality rate between patients with and without ECMO support did not differ (17% vs. 57%, p=0.135).Conclusions: In patients with influenza virus pneumonia-related severe ARDS, ECMO support may be an effective rescue treatment strategy for refractory severe hypoxemia and lead to a significantly higher successful ventilator weaning rate, a lower hospital mortality rate, and better long-term outcome.

關鍵字

急性呼吸窘迫症候群 ； 重症照護 ； 流感病毒性肺炎 ； 體外循環維生系統

並列摘要

Objectives: We compared the clinical outcomes of patients with virus pneumonia and severe acute respiratory distress syndrome (ARDS) status treated with or without extracorporeal membrane oxygenation (ECMO) support.Methods: We retrospectively reviewed the hospital courses of patients who were admitted to intensive care unit (ICU) with severe ARDS (PaO2/FiO2 ＜100 under positive end expiratory pressure ＞5 cmH2O) due to influenza virus pneumonia and who had a period ≤7 days between the onset of influenza and intubation from January 2008 to December 2011. Clinical characteristics and outcomes were compared between patients with and without ECMO support.Results: A total of 13 patients with refractory hypoxemia and severe ARDS status were enrolled. Eleven of the 13 patients had a diagnosis of influenza confirmed by PCR test (8 influenza A (swH1), 2 influenza A (H3) and 1 influenza B), 1 by the influenza rapid test (influenza A) and 1 by bronchoalveolar lavage (BAL) virus isolation (influenza A). Six patients were provided with veno-venous ECMO (vv-ECMO) support and 7 patients received only conventional ventilatory support. Patients who were provided with ECMO support had a higher successful ventilator weaning rate (83.3% vs. 29%, p=0.048) than patients without ECMO support. The hospital mortality rate between patients with and without ECMO support did not differ (17% vs. 57%, p=0.135).Conclusions: In patients with influenza virus pneumonia-related severe ARDS, ECMO support may be an effective rescue treatment strategy for refractory severe hypoxemia and lead to a significantly higher successful ventilator weaning rate, a lower hospital mortality rate, and better long-term outcome.

並列關鍵字

acute respiratory distress syndrome ； critical care ； extracorporeal membrane oxygenation ； influenza viral pneumonia ； mechanical ventilation