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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.

Intensive care medicine, 2016-11, Vol.42 (11), p.1672-1684 [Periódico revisado por pares]

Berlin/Heidelberg: Springer Berlin Heidelberg

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Título:
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
Autor: 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.
Assuntos: Adult ; Age Factors ; Anesthesiology ; Body Mass Index ; Critical Care Medicine ; Emergency Medicine ; Extracorporeal Membrane Oxygenation - instrumentation ; Extracorporeal Membrane Oxygenation - methods ; Female ; Hospital Mortality ; Humans ; Hypoxia - therapy ; Intensive ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Observational Studies as Topic ; Original ; Pain Medicine ; Pediatrics ; Pneumology/Respiratory System ; Positive-Pressure Respiration ; Respiration, Artificial - methods ; Respiratory Distress Syndrome, Adult - mortality ; Respiratory Distress Syndrome, Adult - therapy ; Sex Factors ; Tidal Volume ; Time Factors ; Ventilators, Mechanical - standards
É parte de: Intensive care medicine, 2016-11, Vol.42 (11), p.1672-1684
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Descrição: 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 PaO 2 /FiO 2 , higher arterial pH and lower PaCO 2 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.
Editor: Berlin/Heidelberg: Springer Berlin Heidelberg
Idioma: Inglês

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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

Berlin/Heidelberg: Springer Berlin Heidelberg

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