Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis

Neto, Ary Serpa; Schmidt, Matthieu; Azevedo, Luciano C. P.; Bein, Thomas; Brochard, Laurent; Beutel, Gernot; Combes, Alain; Costa, Eduardo Leite Vieira; Hodgson, Carol; Lindskov, Christian; Lubnow, Matthias; Lueck, Catherina; Michaels, Andrew J.; Paiva, José Artur; Park, Marcelo; Pesenti, Antonio; Pham, Tài; Quintel, Michael; Ranieri, V. Marco; Ried, Michael; Roncon‐Albuquerque, Roberto; Slutsky, Arthur S.; Takeda, Satoru; Terragni, P.; Vejen, Marie; Weber‐Carstens, Steffen; Welte, Tobias; Abreu, Marcelo Gama de; Pelosi, Paolo; Schultz, Marcus J.

doi:10.1007/s00134-016-4507-0

Cited by 178 publications

(64 citation statements)

References 45 publications

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“…Ultra-protective ventilation with extracorporeal lung support may help protect the lungs by decreasing Vt along driving pressure [ 24 ]. In a recent meta-analysis from nine studies, including more than 500 patients receiving extracorporeal membrane oxygenation (ECMO) for refractory hypoxemia, Serpa Neto et al [ 25 ] showed that driving pressure during the first 3 days in ECMO had an independent association with in-hospital mortality. Although ECMO support allowed decreasing Vt to 4 mL/kg IBW and driving pressure in nearly 4 cm H 2 O, non-survivors still showed a higher driving pressure during ECMO (14.5 ± 6.2 versus 13.3 ± 4.8 cm H 2 O in survivors, p = 0.048).…”

Section: What Is the Current Clinical Evidence?mentioning

confidence: 99%

Driving pressure: a marker of severity, a safety limit, or a goal for mechanical ventilation?

2017

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Section: What Is the Current Clinical Evidence?mentioning

confidence: 99%

Driving pressure: a marker of severity, a safety limit, or a goal for mechanical ventilation?

2017

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“…Recent studies suggest a role of ΔP in the risk of developing VILI in ARDS patients under extracorporeal membrane oxygenation or with brain injury . In addition, ΔP and Pplat were associated with mortality and development of ARDS in patients who presented to the emergency department requiring mechanical ventilation .…”

Section: Introductionmentioning

confidence: 99%

Driving pressure and acute respiratory distress syndrome in critically ill patients

et al. 2018

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“…Although the impact of the baseline pressure settings of MV remains equivocal on the outcomes of adult respiratory ECMO, an unreduced static or dynamic driving pressure of MV during the first three days of adult respiratory ECMO is recently reported to be a predictor of hospital mortality in these ECMO-treated patients [ 22 , 23 ]. When the results of these updated investigations on adult respiratory ECMO are reviewed together, researchers may find that there seem to be some links among the duration of MV before ECMO institution, the driving pressure of MV during ECMO, and the outcomes of ECMO.…”

Section: Discussionmentioning

confidence: 99%

The impacts of baseline ventilator parameters on hospital mortality in acute respiratory distress syndrome treated with venovenous extracorporeal membrane oxygenation: a retrospective cohort study

Chang

Huang

et al. 2017

BMC Pulm Med

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BackgroundVenovenous extracorporeal membrane oxygenation (VV-ECMO) is a valuable life support in acute respiratory distress syndrome (ARDS) in adult patients. However, the success of VV-ECMO is known to be influenced by the baseline settings of mechanical ventilation (MV) before its institution. This study was aimed at identifying the baseline ventilator parameters which were independently associated with hospital mortality in non-trauma patients receiving VV-ECMO for severe ARDS.MethodsThis retrospective study included 106 non-trauma patients (mean age: 53 years) who received VV-ECMO for ARDS in a single medical center from 2007 to 2016. The indication of VV-ECMO was severe hypoxemia (PaO2/ FiO2 ratio < 70 mmHg) under pressure-controlled MV with peak inspiratory pressure (PIP) > 35 cmH2O, positive end-expiratory pressure (PEEP) > 5 cmH2O, and FiO2 > 0.8. Important demographic and clinical data before and during VV-ECMO were collected for analysis of hospital mortality.ResultsThe causes of ARDS were bacterial pneumonia (n = 41), viral pneumonia (n = 24), aspiration pneumonitis (n = 3), and others (n = 38). The median duration of MV before ECMO institution was 3 days and the overall hospital mortality was 53% (n = 56). The medians of PaO2/ FiO2 ratio, PIP, PEEP, and dynamic pulmonary compliance (PCdyn) at the beginning of MV were 84 mmHg, 32 cmH2O, 10 cmH2O, and 21 mL/cmH2O, respectively. However, before the beginning of VV-ECMO, the medians of PaO2/ FiO2 ratio, PIP, PEEP, and PCdyn became 69 mmHg, 36 cmH2O, 14 cmH2O, and 19 mL/cmH2O, respectively. The escalation of PIP and the declines in PaO2/ FiO2 ratio and PCdyn were significantly correlated with the duration of MV before ECMO institution. Finally, the duration of MV (OR: 1.184, 95% CI: 1.079–1.565, p < 0.001) was found to be the only baseline ventilator parameter that independently affected the hospital mortality in these ECMO-treated patients.ConclusionSince the duration of MV before ECMO institution was strongly correlated to the outcome of adult respiratory ECMO, medical centers are suggested to find a suitable prognosticating tool to determine the starting point of respiratory ECMO among their candidates with different duration of MV.Trial registrationThis study reported a health care intervention on human participants and was retrospectively registered. The Chang Gung Medical Foundation Institutional Review Board approved the study (no. 201601483B0) on November 23, 2016. All of the data were extracted from December 1, 2016, to January 31, 2017.

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Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis

Abstract: In this series of ARDS patients receiving ECMO for refractory hypoxemia, driving pressure during ECMO was the only ventilator setting that showed an independent association with in-hospital mortality.

Cited by 178 publications

References 45 publications

Driving pressure: a marker of severity, a safety limit, or a goal for mechanical ventilation?

Driving pressure: a marker of severity, a safety limit, or a goal for mechanical ventilation?

Driving pressure and acute respiratory distress syndrome in critically ill patients

The impacts of baseline ventilator parameters on hospital mortality in acute respiratory distress syndrome treated with venovenous extracorporeal membrane oxygenation: a retrospective cohort study

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