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01.09.2016 | Original

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

Mechanical ventilation during ECMO

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

Erschienen in: Intensive Care Medicine | Ausgabe 11/2016

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Abstract

Purpose

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.

Methods

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.

Results

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/FiO₂, 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)].

Conclusion

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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Titel: 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
Mechanical ventilation during ECMO
verfasst von: Ary Serpa Neto
Matthieu Schmidt
Luciano C. P. Azevedo
Thomas Bein
Laurent Brochard
Gernot Beutel
Alain Combes
Eduardo L. V. Costa
Carol Hodgson
Christian Lindskov
Matthias Lubnow
Catherina Lueck
Andrew J. Michaels
Jose-Artur Paiva
Marcelo Park
Antonio Pesenti
Tài Pham
Michael Quintel
V. Marco Ranieri
Michael Ried
Roberto Roncon-Albuquerque Jr
Arthur S. Slutsky
Shinhiro Takeda
Pier Paolo Terragni
Marie Vejen
Steffen Weber-Carstens
Tobias Welte
Marcelo Gama de Abreu
Paolo Pelosi
Marcus J. Schultz
The ReVA Research Network and the PROVE Network Investigators
Publikationsdatum: 01.09.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 11/2016
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-016-4507-0

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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

Mechanical ventilation during ECMO