Current opinion in critical care · 2025
Weaning from venovenous extracorporeal membrane oxygenation for acute respiratory failure: challenges and opportunities.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Greendyk Richard A, Abrams Darryl, Agerstrand Cara
Аннотация
PURPOSE OF REVIEW: The process of weaning from venovenous extracorporeal membrane oxygenation (V-V ECMO) is a critical step in the recovery of patients with severe acute respiratory distress syndrome (ARDS), yet clinical practice is highly variable and lacks strong evidence-based guidance. This review summarizes the current understanding and emerging data on weaning from V-V ECMO while highlighting key areas for future research.
RECENT FINDINGS: While several single-center studies have evaluated structured weaning protocols, no definitive multicenter trial with patient-centered outcomes has been completed. Recent work has highlighted physiologic predictors of successful weaning such as tidal volume, carbon dioxide clearance, and diaphragm function, as well as the challenges posed by ICU-acquired weakness, prolonged ECMO runs, and severe lung injury. Importantly, even patients requiring extended ECMO support can often be weaned successfully, and premature decisions about irreversibility should be avoided.
SUMMARY: The optimal strategy for weaning V-V ECMO remains an area of clinical uncertainty. Protocolized approaches, careful physiologic monitoring, and patience may improve outcomes. Ongoing trials and future research will be critical in shaping evidence-based guidelines for liberation from ECMO support.
RECENT FINDINGS: While several single-center studies have evaluated structured weaning protocols, no definitive multicenter trial with patient-centered outcomes has been completed. Recent work has highlighted physiologic predictors of successful weaning such as tidal volume, carbon dioxide clearance, and diaphragm function, as well as the challenges posed by ICU-acquired weakness, prolonged ECMO runs, and severe lung injury. Importantly, even patients requiring extended ECMO support can often be weaned successfully, and premature decisions about irreversibility should be avoided.
SUMMARY: The optimal strategy for weaning V-V ECMO remains an area of clinical uncertainty. Protocolized approaches, careful physiologic monitoring, and patience may improve outcomes. Ongoing trials and future research will be critical in shaping evidence-based guidelines for liberation from ECMO support.