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

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

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Details

Item type:	Article
Journal or Publication Title:	Intensive Care Medicine
Publisher:	Springer
Place of Publication:	NEW YORK
Volume:	42
Number of Issue or Book Chapter:	11
Page Range:	pp. 1672-1684
Date:	2016
Institutions:	Medicine > Lehrstuhl für Anästhesiologie Medicine > Abteilung für Thoraxchirurgie Medicine > Lehrstuhl für Innere Medizin II
Identification Number:	Value Type 10.1007/s00134-016-4507-0 DOI
Keywords:	MECHANICAL VENTILATION; PROTECTIVE VENTILATION; PREDICTING SURVIVAL; DRIVING PRESSURE; CRITICAL ILLNESS; MORTALITY RISK; ADULT PATIENTS; LIFE-SUPPORT; LUNG INJURY; 6 ML/KG; Mechanical ventilation; ARDS; Refractory hypoxemia; ECMO; PEEP; Driving pressure
Dewey Decimal Classification:	600 Technology > 610 Medical sciences Medicine
Status:	Published
Refereed:	Yes, this version has been refereed
Created at the University of Regensburg:	Yes
Item ID:	42871

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Abstract

Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for patients with acute respiratory distress syndrome (ARDS). The aim of this study was to evaluate associations between ventilatory settings during ECMO for refractory hypoxemia and outcome in ARDS patients. In this individual patient data meta-analysis of observational studies in adult ARDS patients receiving ECMO for refractory ...

Abstract

Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for patients with acute respiratory distress syndrome (ARDS). The aim of this study was to evaluate associations between ventilatory settings during ECMO for refractory hypoxemia and outcome in ARDS patients. In this individual patient data meta-analysis of observational studies in adult ARDS patients receiving ECMO for refractory hypoxemia, a time-dependent frailty model was used to determine which ventilator settings in the first 3 days of ECMO had an independent association with in-hospital mortality. Nine studies including 545 patients were included. Initiation of ECMO was accompanied by significant decreases in tidal volume size, positive end-expiratory pressure (PEEP), plateau pressure, and driving pressure (plateau pressure - PEEP) levels, and respiratory rate and minute ventilation, and resulted in higher PaO2/FiO(2), higher arterial pH and lower PaCO2 levels. Higher age, male gender and lower body mass index were independently associated with mortality. Driving pressure was the only ventilatory parameter during ECMO that showed an independent association with in-hospital mortality [adjusted HR, 1.06 (95 % CI, 1.03-1.10)]. 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.

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Metadata last modified: 03 Feb 2022 11:04

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