Tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an International Multicenter Retrospective Study

Critical Care

Thomas Frapard¹  Sacha Rozencwajg¹  Alexis Serra²  Bianca Bromberger²  Matthias Lubnow³  Thomas Mueller³  Christoph Fisser³  Daniel Brodie⁴  Darryl Abrams⁴  Gennaro Martucci⁵  Giovanni Lino⁵  Antonio Arcadipane⁵  Konstantin Popugaev⁶  Sergey Petrikov⁶  Alain Combes⁷  Matthieu Schmidt⁷  Tài Pham⁸ 

[1] Assistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière Hospital, Medical Intensive Care Unit, 47, bd de l’Hôpital, 75651, Paris Cedex 13, France;Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA;Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany;Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, USA;Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA;IRCCS-ISMETT Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione - Department of Anesthesia and Intensive Care, Palermo, Italy;Sklifosovsky Research Institute of Emergency Medicine, Bolshaya Sukharevskaya squire, 3, Moscow, Russia;Sorbonne Université, Paris 06, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651, Paris Cedex 13, France;Assistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière Hospital, Medical Intensive Care Unit, 47, bd de l’Hôpital, 75651, Paris Cedex 13, France;Université Paris-Saclay, AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Le Kremlin-Bicêtre, France;Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Equipe d’Epidémiologie respiratoire intégrative, CESP, Villejuif, France;

关键词: ECMO;    Acute respiratory distress syndrome;    Mechanical ventilation;    Tracheostomy;    Bleeding;    Outcome;   

DOI  :  10.1186/s13054-021-03649-8

来源: Springer

【 摘 要 】

BackgroundCurrent practices regarding tracheostomy in patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome are unknown. Our objectives were to assess the prevalence and the association between the timing of tracheostomy (during or after ECMO weaning) and related complications, sedative, and analgesic use.MethodsInternational, multicenter, retrospective study in four large volume ECMO centers during a 9-year period.ResultsOf the 1,168 patients treated with ECMO for severe ARDS (age 48 ± 16 years, 76% male, SAPS II score 51 ± 18) during the enrollment period, 353 (30%) and 177 (15%) underwent tracheostomy placement during or after ECMO, respectively. Severe complications were uncommon in both groups. Local bleeding within 24 h of tracheostomy was four times more frequent during ECMO (25 vs 7% after ECMO, p < 0.01). Cumulative sedative consumption decreased more rapidly after the procedure with sedative doses almost negligible 48–72 h later, when tracheostomy was performed after ECMO decannulation (p < 0.01). A significantly increased level of consciousness was observed within 72 h after tracheostomy in the “after ECMO” group, whereas it was unchanged in the “during-ECMO” group.ConclusionIn contrast to patients undergoing tracheostomy after ECMO decannulation, tracheostomy during ECMO was neither associated with a decrease in sedation and analgesia levels nor with an increase in the level of consciousness. This finding together with a higher risk of local bleeding in the days following the procedure reinforces the need for a case-by-case discussion on the balance between risks and benefits of tracheotomy when performed during ECMO.

【 授权许可】

CC BY