Işık Şenkaya SIĞNAK, Ahmet YÜKSEL, İrem İris KAN, Atıf YOLGÖSTEREN, Mehmet Ergun TECİMER, Ali İmran DOĞAN, Haluk MERVE ÖZGÖZ

Akut solunum sıkıntısı sendromunda venovenöz ekstrakorporeal membran oksijenasyonu: Tek merkezli çalışma deneyimimiz

Amaç: Bu çalışmada, akut solunum sıkıntısı sendromunun tedavisinde venovenöz ekstrakorporeal membran oksijenasyonuna ilişkin beş yıllık deneyimimiz sunuldu. Çalışma planı: Kasım 2010 - Kasım 2015 tarihleri arasında konvansiyonel tedaviye dirençli akut solunum sıkıntısı sendromlu 33 hastaya (24 erkek, 9 kadın; ort. yaş 48.6±14.7 yıl; dağılım 19-76 yıl) venovenöz ekstrakorporeal membran oksijenasyonu desteği uygulandı. Venovenöz ekstrakorporeal membran oksijenasyonu desteğinin genel endikasyonu, konvansiyonel tedavinin optimizasyonuna rağmen, refrakter hipoksi, hiperkapni ve solunumsal asidoz idi. Hastaların detaylı klinik verileri retrospektif olarak incelendi. Bulgular: Kanülasyon 24 hastada (%73) femoral-femoral venlerden, dokuz hastada (%27) juguler-femoral venlerden gerçekleştirildi. Ortalama venovenöz ekstrakorporeal membran oksijenasyon desteği 17 (dağılım, 1-52) gün idi. En sık görülen komplikasyon, altı hastada (%18) minör kanama idi. On sekiz hasta (%54.5) başarılı bir şekilde venovenöz ekstrakorporeal membran oksijenasyonu desteğinden ayrıldı. Bu hastaların 13’ü (%39.4) sağkaldı ve hastaneden taburcu edildi. Sonuç: Venovenöz ekstrakorporeal membran oksijenasyonu, şiddetli akut solunum sıkıntısı sendromlu hastalarda hayat kurtarıcı bir tedavi yöntemi olabilir. Sonuçların iyileşmesi, deneyimlerin artması ve venovenöz ekstrakorporeal membran oksijenasyonunun tedavisine yönelik standart bir protokolün oluşturulması ile sağlanabilir.

Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: our single-center experience

Background: In this study, we present our five-year experience with venovenous extracorporeal membrane oxygenation for the treatment of acute respiratory distress syndrome.Methods: Between November 2010 and November 2015, 33 patients (24 males, 9 females; mean age: 48.6±14.7 years; range 19 to 76 years) with acute respiratory distress syndrome refractory to conventional therapy were supported with venovenous extracorporeal membrane oxygenation. The general indication for venovenous extracorporeal membrane oxygenation support was refractory hypoxia, hypercapnia, and respiratory acidosis, despite the optimization of conventional therapy. Detailed clinical data of the patients were retrospectively analyzed.Results: Cannulation was achieved via femoral-femoral veins in 24 patients (73%) and jugular-femoral veins in nine patients (27%). The median duration of venovenous extracorporeal membrane oxygenation support was 17 (range, 1 to 52) days. The most common complication was minor bleeding in six patients (18%). Eighteen patients (54.5%) were successfully weaned from venovenous extracorporeal membrane oxygenation support. Of these patients, 13 (39.4%) survived and were discharged from the hospital.Conclusion: Venovenous extracorporeal membrane oxygenation can be a life-saving treatment modality in patients with severe acute respiratory distress syndrome. Improved results may be provided with increased experience and an established standard protocol for the management of venovenous extracorporeal membrane oxygenation.

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