key: cord-0052947-d48f210p authors: (Shared Research Group in Ministry of Health, Labor and Welfare Scientific Research Grant for a Research for Risk Assessment of Emerging and Re-emerging Infectious Disease and Implementation of Risk Management Function), 厚生労働科学研究費補助金（新興・再興感染症及び予防接種政策推進研究事業）「新興・再興感染症のリスク評価と危機管理機能の実装のための研究」分担研究班* title: COVID–19急性呼吸不全への人工呼吸管理とECMO管理：基本的考え方(Mechanical ventilation and extracorporeal membrane oxygenation for acute respiratory failure owing to COVID–19: basic concept) date: 2020-10-13 journal: nan DOI: 10.1002/jja2.12499 sha: b41306d29aacce737c8185d1d2a20a301a3f99a0 doc_id: 52947 cord_uid: d48f210p The pillars of managing critically ill patients with acute respiratory failure owing to coronavirus disease 2019 (COVID–19) are mechanical ventilation and extracorporeal membrane lung oxygenation (ECMO) as supportive therapies for impaired respiratory function. Given the increasing number of patients with COVID–19, a summary of standardized care regarding ECMO that can serve as a reference in clinical practice is proposed as an expert consensus statement. Indications, management practices, and caveats for ECMO management are described, including those in the presence of resource constraints. VILI)は，⼈⼯呼吸患者の予後を悪くすることが知 られており，2009 年 CESAR trial 4) では， "⾼濃度酸 素もしくは⾼気道内圧で⼈⼯呼吸管理を 7 ⽇以上 ⾏った患者"を exclusion criteria としていた。また近 年では，2018 年 EOLIA trial 5) およびその Post hoc 解 析 6) で，早期の ECMO 導⼊が予後を改善する可能性 が⽰されている。 • PEEP 10cmH 2 O， P/F ⽐<100 で進⾏性に悪化する場 合を⽬安とする。 COVID-19 の臨床経過では，発症から 8-10 ⽇⽬ あたりで呼吸不全が発症し，短時間で ARDS に進⾏ するのが特徴的な経過である 12) 。COVID-19 肺炎は ⽐較的軽症の L 型(肺内含気は正常で肺コンプライ アンスは保たれるが肺循環障害のために低酸素症を 呈するタイプ)と，重症の H 型(肺⽔腫が進⾏し肺 内含気が低下， コンプライアンスが低下するタイプ) に分けられる 13) 。H 型であれば，⼈⼯呼吸のみによ る管理には抵抗性であるため ECMO の適応となりう る。ただし，L 型から H 型への移⾏の判定は難しい。 また，酸素化が増悪し始めると数時間で重篤な低酸 素 状 態 に 陥 る こ と が 多 い 。 ⽬ 安 と し て ， PEEP 10cmH 2 O ， P/F<100 で 進 ⾏ 性 に 悪 化 す る 場 合 は ECMO を考慮する。ELSOguideline Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry Cardiac intensive care units: What should be the standard of care? The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis The impact of hospital and ICU organizational factors on outcome in critically ill patients: results from the extended prevalence of infection in intensive care study An international survey: the role of specialist nurses in adult respiratory extracorporeal membrane oxygenation Clinical features of patients infected with 2019 novel coronavirus in Wuhan COVID-19 pneumonia: different respiratory treatments for different phenotypes? Extracorporeal Life Support Organization (ELSO): Guidelines for adult respiratory failure Age is major factor for predicting survival in patients with acute respiratory failure on extracorporeal membrane oxygenation: a Korean multicenter study Outcomes of venovenous extracorporeal membrane oxygenation when stratified by age: how old is too old? Extracorporeal life support organization COVID-19 interim guidelines; A consensus document from an international group of interdisciplinary ECMO providers. Extracorporeal life support organization Evaluation of extracorporeal perfusion catheters using a standardized measurement technique -the M-number Pediatric femoral arterial cannulations in extracorporeal membrane oxygenation: a review and strategies for optimization Cannulation for ECLS. American Pediatric Surgical Association Saving Lifetimes Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome Extracorporeal membrane oxygenation for adult respiratory failure High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome Management of COVID-19 respiratory distress Ventilator-induced lung injury Mechanical ventilation during extracorporeal membrane oxygenation Practice patterns and ethical considerations in the management of venovenous extracorporeal membrane oxygenation patients: an international survey Iseikyoku-Shidouka/0000197701.pdf. Accessed Coagulation abnormalities and thrombosis in patients with COVID-19 COVID-19 and its implications for thrombosis and anticoagulation