Optimal positive end-expiratory pressure reduces right ventricular dysfunction in COVID-19 patients on venovenous extracorporeal membrane oxygenation: A retrospective single-center study

Estoos, Ethan M.; Jocham, Kevin P.; Zhang, Chengda; Benson, Lauren M.; Milas, Anamaria; Zakhary, Bishoy

doi:10.1016/j.jcrc.2023.154274

Cited by 3 publications

(3 citation statements)

References 21 publications

(30 reference statements)

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“…One study assessed the effect of an optimal PEEP strategy using esophageal manometry (PEEP set to an endexpiratory transpulmonary pressure of 0-3 cm H 2 O) compared to setting the standard PEEP to 10 cmH 2 O, throughout the duration of VV ECMO support. Though the driving pressure was similar between two groups, the optimal PEEP group had reduced rates of hemodynamically signi cant RV dysfunction (4.5% vs. 44.0%, p = 0.0001) and higher rates of survival to liberation from ECMO support (72.7% vs. 44.0%, p = 0.022) [14]. Our systematic search did not identify any studies investigating the effect of prone positioning on RV biomechanics in patients with evidence of RV injury during VV ECMO support.…”

Section: Non-pharmacological Interventions Invasive Ventilation Strat...mentioning

confidence: 90%

“…Thirteen studies (43.3%) reported on RV injury management strategies [11, 13-18, 30-33, 36, 37] but only four studies (12.9%) reported on the effect of interventions on hemodynamics and indices of RV biomechanics [14,16,31,36]. Interventions identi ed included: VP ECMO (single-site dual lumen or dual-site single lumen cannulation), or mode conversion from VV to VP ECMO), veno-arterial (VA) ECMO, inodilator agents (milrinone and dobutamine), pulmonary vasodilators, ultra-lung-protective ventilation targeting a driving pressure level of 10 cmH 2 O, and optimization of positive end-expiratory pressure (PEEP) using esophageal manometry.…”

Section: Rv Injury Management Strategiesmentioning

confidence: 99%

“…Pilot studies investigating ultra-lung-protective ventilation, a strategy that achieves low driving pressure, tidal volume, and mechanical power during VV ECMO or extracorporeal carbon dioxide removal, showed mixed results on its impact on RV dimensions and function [36,54]. Only one study targeted 'optimal' PEEP guided by transpulmonary pressure, resulting in lower rates of hemodynamically signi cant RV injury and improved survival to liberation from ECMO [14]. A similar result was reported in a study, which investigated the effect of three PEEP titration methods on echocardiographic measures of RV injury (including Tei index, TAPSE, RV FAC, and RVEDA/LVEDA) in 62 patients with ARDS [55].…”

Section: Invasive Ventilation Strategiesmentioning

confidence: 99%

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Right ventricular injury definition and management in patients with severe respiratory failure receiving veno-venous extracorporeal membrane oxygenation: a scoping review

Dugar,

Sato,

Charlton

et al. 2024

Preprint

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Purpose: Right ventricular (RV) injury in patients with respiratory failure receiving veno-venous extracorporeal membrane oxygenation (VV ECMO) is associated with significant mortality. A consensus on the definition and management of RV injury in patients receiving VV ECMO is currently lacking. Therefore, a scoping review is necessary to map the current literature and guide future research regarding the definition and management of RV injury in patients receiving VV ECMO. Methods: Using a robust scoping review methodology, we searched for relevant publications on RV injury in patients receiving VV ECMO in Medline, EMBASE, and Web of Science. Two authors extracted the data independently and in duplicate. Results: Of 1,868 citations screened, 30 studies reporting on RV injury during VV ECMO were identified. Of those, twenty-three studies reported on the definition of RV injury including echocardiographic indices of RV function and dimensions (tricuspid annular plane systolic excursion or right to left ventricular end-diastolic area ratio, respectively). Thirteen studies reported on the management of RV injury, including veno-pulmonary (VP) ECMO, veno-arterial (VA) ECMO, positive inotropic agents, pulmonary vasodilators, ultra-lung-protective ventilation, and optimization of positive end-expiratory pressure. Conclusion: The definitions of RV injury in patients receiving VV ECMO used in the literature are heterogeneous. Despite the high incidence of RV injury during VV ECMO support and its strong association with mortality, studies investigating therapeutic strategies for RV injury are lacking. To fill the existing knowledge gaps, a consensus on the definition of RV injury and research investigating RV-targeted therapies during VV ECMO are urgently warranted. Trial Registration The search protocol was registered in the Open Science Framework (https://osf.io/e2km6).

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Section: Non-pharmacological Interventions Invasive Ventilation Strat...mentioning

confidence: 90%

Section: Rv Injury Management Strategiesmentioning

confidence: 99%

Section: Invasive Ventilation Strategiesmentioning

confidence: 99%

See 1 more Smart Citation

Right ventricular injury definition and management in patients with severe respiratory failure receiving veno-venous extracorporeal membrane oxygenation: a scoping review

Dugar,

Sato,

Charlton

et al. 2024

Preprint

View full text Add to dashboard Cite

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Effects of different positive end-expiratory pressure titration strategies on mechanical power during ultraprotective ventilation in ARDS patients treated with veno-venous extracorporeal membrane oxygenation: A prospective interventional study

Boesing,

Schaefer,

Graf

et al. 2024

Journal of Critical Care

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Right ventricle-specific therapies in acute respiratory distress syndrome: a scoping review

et al. 2023

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Objective To summarize knowledge and identify gaps in evidence regarding treatment of right ventricular dysfunction (RVD) in acute respiratory distress syndrome (ARDS). Data sources We conducted a comprehensive search of MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials. Study selection Studies were included if they reported effects of treatments on right ventricular function, whether or not the intent was to modify right ventricular function. Data extraction Data extraction was performed independently and in duplicate by two authors. Data items included the study design, patient population, type of intervention, comparison group, and RV-specific outcomes. Data synthesis Of 1,430 studies screened, 51 studies reporting on 1,526 patients were included. By frequency, the included studies examined the following interventions: ventilator settings (29.4%), inhaled medications (33.3%), extracorporeal life support (13.7%), intravenous or oral medications (13.7%), and prone positioning (9.8%). The majority of the studies were non-randomized experimental studies (53%), with the next most common being case reports (16%). Only 5.9% of studies were RCTs. In total, 27% of studies were conducted with the goal of modifying RV function. Conclusions Given the prevalence of RVD in ARDS and its association with mortality, the dearth of research on this topic is concerning. This review highlights the need for prospective trials aimed at treating RV dysfunction in ARDS.

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Optimal positive end-expiratory pressure reduces right ventricular dysfunction in COVID-19 patients on venovenous extracorporeal membrane oxygenation: A retrospective single-center study

Cited by 3 publications

References 21 publications

Right ventricular injury definition and management in patients with severe respiratory failure receiving veno-venous extracorporeal membrane oxygenation: a scoping review

Right ventricular injury definition and management in patients with severe respiratory failure receiving veno-venous extracorporeal membrane oxygenation: a scoping review

Effects of different positive end-expiratory pressure titration strategies on mechanical power during ultraprotective ventilation in ARDS patients treated with veno-venous extracorporeal membrane oxygenation: A prospective interventional study

Right ventricle-specific therapies in acute respiratory distress syndrome: a scoping review

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