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

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 & 12 others Roberto Roncon-Albuquerque, 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 Investigators, PROVE Network Investigators

Research output: Contribution to journalArticleResearchpeer-review

66 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1672-1684
Number of pages13
JournalIntensive Care Medicine
Volume42
Issue number11
DOIs
Publication statusPublished - 1 Nov 2016

Keywords

  • ARDS
  • Driving pressure
  • ECMO
  • Mechanical ventilation
  • PEEP
  • Refractory hypoxemia

Cite this

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. ; The ReVA Research Network Investigators ; PROVE Network Investigators. / 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. In: Intensive Care Medicine. 2016 ; Vol. 42, No. 11. pp. 1672-1684.
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title = "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.",
keywords = "ARDS, Driving pressure, ECMO, Mechanical ventilation, PEEP, Refractory hypoxemia",
author = "{Serpa Neto}, Ary and Matthieu Schmidt and Azevedo, {Luciano C P} and Thomas Bein and Laurent Brochard and Gernot Beutel and Alain Combes and Costa, {Eduardo L V} and Carol Hodgson and Christian Lindskov and Matthias Lubnow and Catherina Lueck and Michaels, {Andrew J.} and Paiva, {Jose Artur} and Marcelo Park and Antonio Pesenti and T{\`a}i Pham and Michael Quintel and {Marco Ranieri}, V. and Michael Ried and Roberto Roncon-Albuquerque and Slutsky, {Arthur S.} and Shinhiro Takeda and Terragni, {Pier Paolo} and Marie Vejen and Steffen Weber-Carstens and Tobias Welte and {Gama de Abreu}, Marcelo and Paolo Pelosi and Schultz, {Marcus J.} and {The ReVA Research Network Investigators} and {PROVE Network Investigators}",
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month = "11",
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language = "English",
volume = "42",
pages = "1672--1684",
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Serpa Neto, A, Schmidt, M, Azevedo, LCP, Bein, T, Brochard, L, Beutel, G, Combes, A, Costa, ELV, Hodgson, C, Lindskov, C, Lubnow, M, Lueck, C, Michaels, AJ, Paiva, JA, Park, M, Pesenti, A, Pham, T, Quintel, M, Marco Ranieri, V, Ried, M, Roncon-Albuquerque, R, Slutsky, AS, Takeda, S, Terragni, PP, Vejen, M, Weber-Carstens, S, Welte, T, Gama de Abreu, M, Pelosi, P, Schultz, MJ, The ReVA Research Network Investigators & PROVE Network Investigators 2016, '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', Intensive Care Medicine, vol. 42, no. 11, pp. 1672-1684. https://doi.org/10.1007/s00134-016-4507-0

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. / 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.; The ReVA Research Network Investigators; PROVE Network Investigators.

In: Intensive Care Medicine, Vol. 42, No. 11, 01.11.2016, p. 1672-1684.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome

T2 - a pooled individual patient data analysis: Mechanical ventilation during ECMO

AU - Serpa Neto, Ary

AU - Schmidt, Matthieu

AU - Azevedo, Luciano C P

AU - Bein, Thomas

AU - Brochard, Laurent

AU - Beutel, Gernot

AU - Combes, Alain

AU - Costa, Eduardo L V

AU - Hodgson, Carol

AU - Lindskov, Christian

AU - Lubnow, Matthias

AU - Lueck, Catherina

AU - Michaels, Andrew J.

AU - Paiva, Jose Artur

AU - Park, Marcelo

AU - Pesenti, Antonio

AU - Pham, Tài

AU - Quintel, Michael

AU - Marco Ranieri, V.

AU - Ried, Michael

AU - Roncon-Albuquerque, Roberto

AU - Slutsky, Arthur S.

AU - Takeda, Shinhiro

AU - Terragni, Pier Paolo

AU - Vejen, Marie

AU - Weber-Carstens, Steffen

AU - Welte, Tobias

AU - Gama de Abreu, Marcelo

AU - Pelosi, Paolo

AU - Schultz, Marcus J.

AU - The ReVA Research Network Investigators

AU - PROVE Network Investigators

PY - 2016/11/1

Y1 - 2016/11/1

N2 - 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.

AB - 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.

KW - ARDS

KW - Driving pressure

KW - ECMO

KW - Mechanical ventilation

KW - PEEP

KW - Refractory hypoxemia

UR - http://www.scopus.com/inward/record.url?scp=84984861255&partnerID=8YFLogxK

U2 - 10.1007/s00134-016-4507-0

DO - 10.1007/s00134-016-4507-0

M3 - Article

VL - 42

SP - 1672

EP - 1684

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

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ER -