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.

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.

• Authors: 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, ReVA Research Network and the PROVE Network Investigators
• Journal: Intensive care medicine (Intensive Care Med) Vol. 42 Issue 11 Pg. 1672-1684 (Nov 2016) ISSN: 1432-1238 [Electronic] United States
• PMID: 27586996 (Publication Type: Evaluation Study, Journal Article, Meta-Analysis)

Topics

• Adult
• Age Factors
• Body Mass Index
• Extracorporeal Membrane Oxygenation (instrumentation, methods)
• Female
• Hospital Mortality
• Humans
• Hypoxia (therapy)
• Male
• Middle Aged
• Observational Studies as Topic
• Positive-Pressure Respiration
• Respiration, Artificial (methods)
• Respiratory Distress Syndrome (mortality, therapy)
• Sex Factors
• Tidal Volume
• Time Factors
• Ventilators, Mechanical (standards)