Near-Apneic Ventilation Decreases Lung Injury and Fibroproliferation in an Acute Respiratory Distress Syndrome Model with Extracorporeal Membrane Oxygenation

Araos, Joaquín; Alegría, Leyla; Garcia, Patricio; Cruces, Pablo; Soto, Dagoberto; Erranz, Benjamín; Amthauer, Macarena; Salomón, Tatiana; Medina, Tania; Rodríguez, Felipe; Ayala, Pedro; Borzone, Gisella; Meneses, Manuel; Damiani, Felipe; Retamal, Jaime; Cornejo, Rodrigo; Bugedo, Guillermo; Bruhn, Alejandro

doi:10.1164/rccm.201805-0869oc

Cited by 86 publications

(73 citation statements)

References 30 publications

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“…Some degree of ventilation, while maintaining PEEP ≥ 10 cmH 2 O, during ECMO improved survival in a retrospective study [ 57 ]. On the other hand, a larger reduction in mechanical ventilation intensity through lower driving pressure [ 58 ] was associated with lower mortality and near-apneic ventilation resulted in fewer histological lesions of lung injury in an animal model [ 59 ]. Similarly, decreasing respiratory rate (< 10–15 breaths/min) to reduce mechanical power seems desirable [ 49 , 50 ], although it may be achieved in most ARDS patients only with deep sedation and neuromuscular blockade.…”

Section: Specific Management During Vv-ecmomentioning

confidence: 99%

Extracorporeal life support for adults with acute respiratory distress syndrome

et al. 2020

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Extracorporeal life support (ECLS) can support gas exchange in patients with the acute respiratory distress syndrome (ARDS). During ECLS, venous blood is drained from a central vein via a cannula, pumped through a semipermeable membrane that permits diffusion of oxygen and carbon dioxide, and returned via a cannula to a central vein. Two related forms of ECLS are used. Venovenous extracorporeal membrane oxygenation (ECMO), which uses high blood flow rates to both oxygenate the blood and remove carbon dioxide, may be considered in patients with severe ARDS whose oxygenation or ventilation cannot be maintained adequately with best practice conventional mechanical ventilation and adjunctive therapies, including prone positioning. Extracorporeal carbon dioxide removal (ECCO 2 R) uses lower blood flow rates through smaller cannulae and provides substantial CO 2 elimination (~ 20–70% of total CO 2 production), albeit with marginal improvement in oxygenation. The rationale for using ECCO 2 R in ARDS is to facilitate lung-protective ventilation by allowing a reduction of tidal volume, respiratory rate, plateau pressure, driving pressure and mechanical power delivered by the mechanical ventilator. This narrative review summarizes physiological concepts related to ECLS, as well as the rationale and evidence supporting ECMO and ECCO 2 R for the treatment of ARDS. It also reviews complications, limitations, and the ethical dilemmas that can arise in treating patients with ECLS. Finally, it discusses future key research questions and challenges for this technology.

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Section: Specific Management During Vv-ecmomentioning

confidence: 99%

Extracorporeal life support for adults with acute respiratory distress syndrome

et al. 2020

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“…It is imperative to understand that ECMO neither treats nor cures a disease, as the fundamental principle of ECMO consists of allowing the lungs to "rest" while the primary therapy, such as antiviral treatment, can take effect with less concern for ventilator-induced lung injury [29,30]. This notion is confirmed in the current case report, where the beneficial adjunctive effects of ECMO likely supported the patient's viral clearance by the antiviral therapy through the compassionate use indication for remdesivir [13].…”

Section: Discussionmentioning

confidence: 99%

Successful COVID-19 rescue therapy by extra-corporeal membrane oxygenation (ECMO) for respiratory failure: a case report

et al. 2020

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Background: The value of extracorporeal membrane oxygenation (ECMO) for patients suffering from novel coronavirus disease 2019 (COVID-19) as a rescue therapy for respiratory failure remains controversial and associated with high mortality rates of 50 to 82% in early reports from Wuhan, China. We hypothesized that patient outcomes would be improved at our tertiary cardiothoracic surgery referral center with a protocolized team-approach for ECMO treatment of patients with severe COVID-19 disease. Case presentation: A 51-year-old healthy female developed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) bilateral pneumonia while vacationing in Colorado with her family. She was transferred to our facility for a higher level of care. Her respiratory status continued to deteriorate despite maximized critical care, including prone positioning ventilation and nitric oxide inhalation therapy. Veno-venous ECMO was initiated on hospital day 7 in conjunction with a 10-day course of compassionate use antiviral treatment with remdesivir. The patient's condition improved significantly and she was decannulated from ECMO on hospital day 17 (ECMO day 11). She was successfully extubated and eventually discharged to rehabilitation on hospital day 28. Conclusion: This case report demonstrates a positive outcome in a young patient with COVID-19 treated by the judicious application of ECMO in conjunction with compassionate use antiviral treatment (remdesivir). Future prospective multi-center studies are needed to validate these findings in a larger cohort of patients.

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“…Based on the data available in the LUNG SAFE study, patients with a lower respiratory rate had better survival [12]. Taking these two variables together, animal data indeed suggest that near apnoeic ventilation would have a reductive effect on lung inflammation [140].…”

Section: Mechanical Ventilation In Ecmomentioning

confidence: 99%

ERS International Congress, Madrid, 2019: highlights from the Respiratory Intensive Care Assembly

et al. 2020

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The Respiratory Intensive Care Assembly of the European Respiratory Society is delighted to present the highlights from the 2019 International Congress in Madrid, Spain. We have selected four sessions that discussed recent advances in a wide range of topics: from acute respiratory failure to cough augmentation in neuromuscular disorders and from extra-corporeal life support to difficult ventilator weaning. The subjects are summarised by early career members in close collaboration with the Assembly leadership. We aim to give the reader an update on the most important developments discussed at the conference. Each session is further summarised into a short list of take-home messages.

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Near-Apneic Ventilation Decreases Lung Injury and Fibroproliferation in an Acute Respiratory Distress Syndrome Model with Extracorporeal Membrane Oxygenation

Abstract: In an ARDS model supported with ECMO, near-apneic ventilation decreased histologic lung injury and matrix-metalloproteinase activity, and prevented the expression of myofibroblast markers.

Cited by 86 publications

References 30 publications

Extracorporeal life support for adults with acute respiratory distress syndrome

Extracorporeal life support for adults with acute respiratory distress syndrome

Successful COVID-19 rescue therapy by extra-corporeal membrane oxygenation (ECMO) for respiratory failure: a case report

ERS International Congress, Madrid, 2019: highlights from the Respiratory Intensive Care Assembly

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