Individualized Multimodal Physiologic Approach to Mechanical Ventilation in Patients With Obesity and Severe Acute Respiratory Distress Syndrome Reduced Venovenous Extracorporeal Membrane Oxygenation Utilization.

Autor:	Zadek F; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Rubin J; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Grassi L; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Van Den Kroonenberg D; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Larson G; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Capriles M; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., De Santis Santiago R; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Florio G; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Imber DA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Bittner EA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Hibbert KA; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Legassey A; Department of Respiratory Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA., LaRocque J; Department of Respiratory Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Cudemus-Deseda G; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Bagchi A; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Crowley J; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Shelton K; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Kacmarek R; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.; Department of Respiratory Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Berra L; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.; Department of Respiratory Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Jazyk:	angličtina
Zdroj:	Critical care explorations [Crit Care Explor] 2021 Jun 29; Vol. 3 (7), pp. e0461. Date of Electronic Publication: 2021 Jun 29 (Print Publication: 2021).
DOI:	10.1097/CCE.0000000000000461
Abstrakt:	Objective: To investigate whether individualized optimization of mechanical ventilation through the implementation of a lung rescue team could reduce the need for venovenous extracorporeal membrane oxygenation in patients with obesity and acute respiratory distress syndrome and decrease ICU and hospital length of stay and mortality. Design: Single-center, retrospective study at the Massachusetts General Hospital from June 2015 to June 2019. Patients: All patients with obesity and acute respiratory distress syndrome who were referred for venovenous extracorporeal membrane oxygenation evaluation due to hypoxemic respiratory failure. Intervention: Evaluation and individualized optimization of mechanical ventilation by the lung rescue team before the decision to proceed with venovenous extracorporeal membrane oxygenation. The control group was those patients managed according to hospital standard of care without lung rescue team evaluation. Measurement and Main Results: All 20 patients (100%) allocated in the control group received venovenous extracorporeal membrane oxygenation, whereas 10 of 13 patients (77%) evaluated by the lung rescue team did not receive venovenous extracorporeal membrane oxygenation. Patients who underwent lung rescue team evaluation had a shorter duration of mechanical ventilation ( p = 0.03) and shorter ICU length of stay ( p = 0.03). There were no differences between groups in in-hospital, 30-day, or 1-year mortality. Conclusions: In this hypothesis-generating study, individualized optimization of mechanical ventilation of patients with acute respiratory distress syndrome and obesity by a lung rescue team was associated with a decrease in the utilization of venovenous extracorporeal membrane oxygenation, duration of mechanical ventilation, and ICU length of stay. Mortality was not modified by the lung rescue team intervention. Competing Interests: Dr. Kacmarek is a consultant for Medtronic and Orange Med and has received research grants from Medtronic and Venner Medical (Danischenhagen, Germany). Dr. Berra receives salary support from K23 HL128882/National Heart, Lung, and Blood Institute National Institutes of Health as principal investigator for his work on hemolysis and nitric oxide. He receives technologies and devices from inhaled nitric oxide (iNO) Therapeutics LLC, Praxair Inc., Masimo Corp. he receives grants from “Fast Grants for COVID-19 research” at Mercatus Center of George Mason University and from iNO Therapeutics LLC. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu