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【文献导读】NEJM：体外膜肺氧合联合俯卧位治疗急性呼吸窘迫综合征：汇总个体患者数据分析
文章来源：IE-learning急危重症学习平台发布时间：2022-03-05 22:48
Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a pooled individual patient data analysis
体外膜肺氧合联合俯卧位治疗急性呼吸窘迫综合征：汇总个体患者数据分析
编译：IE-learning文献团队
Background
Prone positioning (PP) reduces mortality of patients with acute respiratory distress syndrome (ARDS). The potential benefit of prone positioning maneuvers during venovenous extracorporeal membrane oxygenation (ECMO) is unknown. The aim of this study was to evaluate the association between the use of prone positioning during extracorporeal support and ICU mortality in a pooled population of patients from previous European cohort studies.
背景
俯卧位(PP)可降低急性呼吸窘迫综合征(ARDS)患者的死亡率。静脉-静脉体外膜氧合(ECMO)中俯卧位操作的潜在益处尚不清楚。这项研究的目的是评估在体外支持期间使用俯卧位与ICU死亡率之间的关系，这些患者来自以前的欧洲队列研究。
Methods
We performed a pooled individual patient data analysis of European cohort studies which compared patients treated with prone positioning during ECMO (Prone group) to “conventional” ECMO management (Supine group) in patients with severe ARDS.
方法
研究者对欧洲队列研究进行了合并的个体患者数据分析，比较了严重ARDS患者在ECMO期间采用俯卧位治疗(俯卧组)和“常规”ECMO治疗(仰卧组)的患者。
Results
889 patients from five studies were included. Unadjusted ICU mortality was 52.8% in the Supine Group and 40.8% in the Prone group. At a Cox multiple regression analysis PP during ECMO was not significantly associated with a reduction of ICU mortality (HR 0.67 95% CI: 0.42–1.06). Propensity score matching identified 227 patients in each group. ICU mortality of the matched samples was 48.0% and 39.6% for patients in the Supine and Prone group, respectively (p=0.072).
结果
纳入了来自5个研究的889名患者。未调整的仰卧组ICU死亡率为52.8%，俯卧组为40.8%。Cox多元回归分析显示，体外膜肺氧合联合俯卧位与ICU死亡率的降低无明显相关性(HR为0.67，95% CI：0.42-1.06)。倾向评分匹配确定了每组227名患者。在仰卧组和俯卧组，匹配样本的重症监护病房死亡率分别为48.0%和39.6% (p=0.072)。
Conclusions
In a large population of ARDS patients receiving venovenous extracorporeal support, the use of prone positioning during ECMO was not significantly associated with reduced ICU mortality. The impact of this procedure will have to be definitively assessed by prospective randomized controlled trials.
结论
在众多接受静脉-静脉体外支持的ARDS患者中，ECMO期间使用俯卧位与降低ICU死亡率没有显著相关性。这一过程的影响将必须通过前瞻性的随机对照试验进行最终评估。
原文链接
https://www.nejm.org/doi/full/10.1056/NEJMoa2101909
体外膜肺氧合联合俯卧位治疗急性呼吸窘迫综合征：汇总个体患者数据分析
编译：IE-learning文献团队
Background
Prone positioning (PP) reduces mortality of patients with acute respiratory distress syndrome (ARDS). The potential benefit of prone positioning maneuvers during venovenous extracorporeal membrane oxygenation (ECMO) is unknown. The aim of this study was to evaluate the association between the use of prone positioning during extracorporeal support and ICU mortality in a pooled population of patients from previous European cohort studies.
背景
俯卧位(PP)可降低急性呼吸窘迫综合征(ARDS)患者的死亡率。静脉-静脉体外膜氧合(ECMO)中俯卧位操作的潜在益处尚不清楚。这项研究的目的是评估在体外支持期间使用俯卧位与ICU死亡率之间的关系，这些患者来自以前的欧洲队列研究。
Methods
We performed a pooled individual patient data analysis of European cohort studies which compared patients treated with prone positioning during ECMO (Prone group) to “conventional” ECMO management (Supine group) in patients with severe ARDS.
方法
研究者对欧洲队列研究进行了合并的个体患者数据分析，比较了严重ARDS患者在ECMO期间采用俯卧位治疗(俯卧组)和“常规”ECMO治疗(仰卧组)的患者。
Results
889 patients from five studies were included. Unadjusted ICU mortality was 52.8% in the Supine Group and 40.8% in the Prone group. At a Cox multiple regression analysis PP during ECMO was not significantly associated with a reduction of ICU mortality (HR 0.67 95% CI: 0.42–1.06). Propensity score matching identified 227 patients in each group. ICU mortality of the matched samples was 48.0% and 39.6% for patients in the Supine and Prone group, respectively (p=0.072).
结果
纳入了来自5个研究的889名患者。未调整的仰卧组ICU死亡率为52.8%，俯卧组为40.8%。Cox多元回归分析显示，体外膜肺氧合联合俯卧位与ICU死亡率的降低无明显相关性(HR为0.67，95% CI：0.42-1.06)。倾向评分匹配确定了每组227名患者。在仰卧组和俯卧组，匹配样本的重症监护病房死亡率分别为48.0%和39.6% (p=0.072)。
Conclusions
In a large population of ARDS patients receiving venovenous extracorporeal support, the use of prone positioning during ECMO was not significantly associated with reduced ICU mortality. The impact of this procedure will have to be definitively assessed by prospective randomized controlled trials.
结论
在众多接受静脉-静脉体外支持的ARDS患者中，ECMO期间使用俯卧位与降低ICU死亡率没有显著相关性。这一过程的影响将必须通过前瞻性的随机对照试验进行最终评估。
原文链接
https://www.nejm.org/doi/full/10.1056/NEJMoa2101909