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 language | English |
|---|---|
| Pages (from-to) | 1672-1684 |
| Number of pages | 13 |
| Journal | Intensive Care Medicine |
| Volume | 42 |
| Issue number | 11 |
| DOIs | |
| Publication status | Published - 1 Nov 2016 |
Keywords
- ARDS
- Driving pressure
- ECMO
- Mechanical ventilation
- PEEP
- Refractory hypoxemia
Cite this
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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. / 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 journal › Article › Research › peer-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
IS - 11
ER -