VV-ECMO Circuit Flow Impact on General Oxygen Delivery, Synchronisation with Patients Needs
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Date
2022
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Venovenozo ekstrakorporālo membrānu oksigenāciju (VV-EKMO) parasti izmanto kā pēdējo līdzekli akūta respiratorā distresa sindroma gadījumā. VV-EKMO lietošana pēdējo divdesmit gadu laikā ieverojami palielinājās, pēdējo 15 gadu laikā četrkāršojas. CESAR un EOLIA pētijumi, kā arī ELSO vadlīnijas spēja pārliecināt daudzus profesionāļus biežāk lietot EKMO, lai gan izdzīvošanas rādītāji būtiski neuzlabojās.32 VV-EKMO galvenā funkcija ir uzlabot skābekļa piegādi (DO2), DO2 efektivitāte ir labvelīgi saistīta ar izdzīvošanas rādītājiem. Šajā rakstā autori apskatīja dažādus pacientus un EKMO režīmus, saistītos faktorus, kas pozitīvi vai negatīvi ietekmē DO2 un patēriņu (VO2). Kā šobrīd ir skaidrs, DO2 efektivitāte lielā mērā ir atkarīga no dažādu EKMO komponentu sinhronizāciju ar pacienta elpošanu un sirdsdarbību. Autori izvirzīja hipotēzi, ka EKMO: MPMV (mākslīgā plaušu minūtes ventilācija): CO (sirds izvade) = 1:1:1 sinhronizācijas attiecība saistīta ar labāko DO2 līmeni atbilstoši pacientu vajadzībām. Ar šo tēmu saistītās zinātniskās literatūras apskatā bija skaidrs, ka CO un EKMO plūsmas sinhronizēšana uzlabo DO2, klīniskos rezultātus un dzīves kvalitāti. Nav veikts pietiekami daudz pētījumu par MPMV sinhronizāciju ar EKMO plūsmu vai CO, tāpēc tas joprojām ir turpmāko preklīnisko eksperimentālo un klīnisko pētījumu priekšmets.
Venovenous Extracorporeal membrane oxygenation (VV-ECMO) is typically used as a last resort treatment in acute respiratory distress syndrome. VV-ECMO use has significantly risen over the last couple of decades, quadrupling in the last 15 years. CESAR and EOLIA trials as well as ELSO guidelines were able to convince many professionals to use ECMO more often although survival rates didn’t improve significantly.32 Primary function of VV-ECMO is to improve oxygen delivery (DO2), efficiency of DO2 is positively related to survival rates. In this article the author reviewed various patients and ECMO modes associated factors which positively or negatively affect DO2 and consumption (VO2). As it is clear by now, efficiency of DO2 is highly dependent on the synchronisation of various components of ECMO setup with patient's respiratory and cardiovascular system work. The author hypothesised that ECMO: ALMV (artificial lung minute ventilation): CO (cardiac output) = 1:1:1 synchronisation ratio associated with best - 100% DO2 rate according to patients' needs. In a review of scientific literature related to this topic it was clear that synchronising CO and ECMO flow improves DO2, clinical outcomes and quality of life. Not enough research has been made on synchronising ALMV with either ECMO flow or CO therefore it remains a subject for future preclinical experimental and clinical studies.
Venovenous Extracorporeal membrane oxygenation (VV-ECMO) is typically used as a last resort treatment in acute respiratory distress syndrome. VV-ECMO use has significantly risen over the last couple of decades, quadrupling in the last 15 years. CESAR and EOLIA trials as well as ELSO guidelines were able to convince many professionals to use ECMO more often although survival rates didn’t improve significantly.32 Primary function of VV-ECMO is to improve oxygen delivery (DO2), efficiency of DO2 is positively related to survival rates. In this article the author reviewed various patients and ECMO modes associated factors which positively or negatively affect DO2 and consumption (VO2). As it is clear by now, efficiency of DO2 is highly dependent on the synchronisation of various components of ECMO setup with patient's respiratory and cardiovascular system work. The author hypothesised that ECMO: ALMV (artificial lung minute ventilation): CO (cardiac output) = 1:1:1 synchronisation ratio associated with best - 100% DO2 rate according to patients' needs. In a review of scientific literature related to this topic it was clear that synchronising CO and ECMO flow improves DO2, clinical outcomes and quality of life. Not enough research has been made on synchronising ALMV with either ECMO flow or CO therefore it remains a subject for future preclinical experimental and clinical studies.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Venovenozās ekstrakorporālās membrānas oksigenācija (VV-EKMO); skābekļa padeve (DO2), skābekļa patēriņš (VO2); MPMV (mākslīgā plaušu minūšu ventilācija); CO (sirds izvade), Venovenous Extracorporeal membrane oxygenation (VV-ECMO); oxygen delivery (DO2), oxygen consumption (VO2); ALMV (artificial lung minute ventilation); CO (cardiac output)