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
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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; Ranieri, V Marco; 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; ReVA Research Network and the PROVE Network Investigators.
In: INTENS CARE MED, Vol. 42, No. 11, 11.2016, p. 1672-1684.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - 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
T2 - 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 - Ranieri, V Marco
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 - ReVA Research Network and the PROVE Network Investigators
PY - 2016/11
Y1 - 2016/11
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 - Adult
KW - Age Factors
KW - Body Mass Index
KW - Extracorporeal Membrane Oxygenation/instrumentation
KW - Female
KW - Hospital Mortality
KW - Humans
KW - Hypoxia/therapy
KW - Male
KW - Middle Aged
KW - Observational Studies as Topic
KW - Positive-Pressure Respiration
KW - Respiration, Artificial/methods
KW - Respiratory Distress Syndrome/mortality
KW - Sex Factors
KW - Tidal Volume
KW - Time Factors
KW - Ventilators, Mechanical/standards
U2 - 10.1007/s00134-016-4507-0
DO - 10.1007/s00134-016-4507-0
M3 - SCORING: Journal article
C2 - 27586996
VL - 42
SP - 1672
EP - 1684
JO - INTENS CARE MED
JF - INTENS CARE MED
SN - 0342-4642
IS - 11
ER -