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Application of extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome induced by avian influenza A (H7N9) viral pneumonia: national data from the Chinese multicentre collaboration
BACKGROUND: Evidence concerning the efficacy and safety of extracorporeal membrane oxygenation (ECMO) in patients with influenza A (H7N9) has been was limited to case reports. Our study is aimed to investigate the current application, efficacy and safety of ECMO in for severe H7N9 pneumonia-associat...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759204/ https://www.ncbi.nlm.nih.gov/pubmed/29310581 http://dx.doi.org/10.1186/s12879-017-2903-x |
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author | Huang, Linna Zhang, Wei Yang, Yi Wu, Wenjuan Lu, Weihua Xue, Han Zhao, Hongsheng Wu, Yunfu Shang, Jia Cai, Lihua Liu, Long Liu, Donglin Wang, Yeming Cao, Bin Zhan, Qingyuan Wang, Chen |
author_facet | Huang, Linna Zhang, Wei Yang, Yi Wu, Wenjuan Lu, Weihua Xue, Han Zhao, Hongsheng Wu, Yunfu Shang, Jia Cai, Lihua Liu, Long Liu, Donglin Wang, Yeming Cao, Bin Zhan, Qingyuan Wang, Chen |
author_sort | Huang, Linna |
collection | PubMed |
description | BACKGROUND: Evidence concerning the efficacy and safety of extracorporeal membrane oxygenation (ECMO) in patients with influenza A (H7N9) has been was limited to case reports. Our study is aimed to investigate the current application, efficacy and safety of ECMO in for severe H7N9 pneumonia-associated acute respiratory distress syndrome (ARDS) in the Chinese population. METHODS: A multicentre retrospective cohort study was conducted at 20 hospitals that admitted patients with avian influenza A (H7N9) viral pneumonia patients’ admission from 9 provinces in China between October 1, 2016, and March 1, 2017. Data from the National Health and Family Planning Commission of China, including general conditions, outcomes and ECMO management, were analysed. Then, successfully weaned and unsuccessfully weaned groups were compared. RESULTS: A total of 35 patients, aged 57 ± 1 years, were analysed; 65.7% of patients were male with 63% mortality. All patients underwent invasive positive pressure ventilation (IPPV), and rescue ventilation strategies were implemented for 23 cases (65.7%) with an average IPPV duration of 5 ± 1 d, PaO(2)/FiO(2) of 78 ± 23 mmHg, tidal volume (VT) of 439 ± 61 ml and plateau pressure (P(plat)) of 29 ± 8 cmH(2)O pre-ECMO. After 48 h on ECMO, PaO(2) improved from 56 ± 21 mmHg to 90 ± 24 mmHg and PaCO(2) declined from 52 ± 24 mmHg to 38 ± 24 mmHg. Haemorrhage, ventilator-associated pneumonia (VAP) and barotrauma occurred in 45.7%, 60% and 8.6% of patients, respectively. Compared with successfully weaned patients (n = 14), the 21 unsuccessfully weaned patients had a longer duration of IPPV pre-ECMO (6 ± 4 d vs. 2 ± 1 d, P < 0.01) as well as a higher P(plat) (25 ± 5 cmH(2)O vs. 21 ± 3 cmH(2)O, P < 0.05) and VT (343 ± 96 ml vs. 246 ± 93 ml, P < 0.05) after 48 h on ECMO support. Furthermore, the unsuccessfully weaned group had a higher mortality (100% vs. 7.1%, P < 0.01) with more haemorrhage (77.3% vs. 28.6%, P < 0.01). CONCLUSIONS: ECMO is effective at improving oxygenation and ventilation of patients with avian influenza A (H7N9) induced severe ARDS. Early initiation of ECMO with appropriate IPPV settings and anticoagulation strategies are necessary to reduce complications. |
format | Online Article Text |
id | pubmed-5759204 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-57592042018-01-10 Application of extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome induced by avian influenza A (H7N9) viral pneumonia: national data from the Chinese multicentre collaboration Huang, Linna Zhang, Wei Yang, Yi Wu, Wenjuan Lu, Weihua Xue, Han Zhao, Hongsheng Wu, Yunfu Shang, Jia Cai, Lihua Liu, Long Liu, Donglin Wang, Yeming Cao, Bin Zhan, Qingyuan Wang, Chen BMC Infect Dis Research Article BACKGROUND: Evidence concerning the efficacy and safety of extracorporeal membrane oxygenation (ECMO) in patients with influenza A (H7N9) has been was limited to case reports. Our study is aimed to investigate the current application, efficacy and safety of ECMO in for severe H7N9 pneumonia-associated acute respiratory distress syndrome (ARDS) in the Chinese population. METHODS: A multicentre retrospective cohort study was conducted at 20 hospitals that admitted patients with avian influenza A (H7N9) viral pneumonia patients’ admission from 9 provinces in China between October 1, 2016, and March 1, 2017. Data from the National Health and Family Planning Commission of China, including general conditions, outcomes and ECMO management, were analysed. Then, successfully weaned and unsuccessfully weaned groups were compared. RESULTS: A total of 35 patients, aged 57 ± 1 years, were analysed; 65.7% of patients were male with 63% mortality. All patients underwent invasive positive pressure ventilation (IPPV), and rescue ventilation strategies were implemented for 23 cases (65.7%) with an average IPPV duration of 5 ± 1 d, PaO(2)/FiO(2) of 78 ± 23 mmHg, tidal volume (VT) of 439 ± 61 ml and plateau pressure (P(plat)) of 29 ± 8 cmH(2)O pre-ECMO. After 48 h on ECMO, PaO(2) improved from 56 ± 21 mmHg to 90 ± 24 mmHg and PaCO(2) declined from 52 ± 24 mmHg to 38 ± 24 mmHg. Haemorrhage, ventilator-associated pneumonia (VAP) and barotrauma occurred in 45.7%, 60% and 8.6% of patients, respectively. Compared with successfully weaned patients (n = 14), the 21 unsuccessfully weaned patients had a longer duration of IPPV pre-ECMO (6 ± 4 d vs. 2 ± 1 d, P < 0.01) as well as a higher P(plat) (25 ± 5 cmH(2)O vs. 21 ± 3 cmH(2)O, P < 0.05) and VT (343 ± 96 ml vs. 246 ± 93 ml, P < 0.05) after 48 h on ECMO support. Furthermore, the unsuccessfully weaned group had a higher mortality (100% vs. 7.1%, P < 0.01) with more haemorrhage (77.3% vs. 28.6%, P < 0.01). CONCLUSIONS: ECMO is effective at improving oxygenation and ventilation of patients with avian influenza A (H7N9) induced severe ARDS. Early initiation of ECMO with appropriate IPPV settings and anticoagulation strategies are necessary to reduce complications. BioMed Central 2018-01-08 /pmc/articles/PMC5759204/ /pubmed/29310581 http://dx.doi.org/10.1186/s12879-017-2903-x Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Huang, Linna Zhang, Wei Yang, Yi Wu, Wenjuan Lu, Weihua Xue, Han Zhao, Hongsheng Wu, Yunfu Shang, Jia Cai, Lihua Liu, Long Liu, Donglin Wang, Yeming Cao, Bin Zhan, Qingyuan Wang, Chen Application of extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome induced by avian influenza A (H7N9) viral pneumonia: national data from the Chinese multicentre collaboration |
title | Application of extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome induced by avian influenza A (H7N9) viral pneumonia: national data from the Chinese multicentre collaboration |
title_full | Application of extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome induced by avian influenza A (H7N9) viral pneumonia: national data from the Chinese multicentre collaboration |
title_fullStr | Application of extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome induced by avian influenza A (H7N9) viral pneumonia: national data from the Chinese multicentre collaboration |
title_full_unstemmed | Application of extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome induced by avian influenza A (H7N9) viral pneumonia: national data from the Chinese multicentre collaboration |
title_short | Application of extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome induced by avian influenza A (H7N9) viral pneumonia: national data from the Chinese multicentre collaboration |
title_sort | application of extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome induced by avian influenza a (h7n9) viral pneumonia: national data from the chinese multicentre collaboration |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759204/ https://www.ncbi.nlm.nih.gov/pubmed/29310581 http://dx.doi.org/10.1186/s12879-017-2903-x |
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