Mechanical Ventilation Strategy Guided by Transpulmonary Pressure in Severe Acute Respiratory Distress Syndrome Treated With Venovenous Extracorporeal Membrane Oxygenation
| Autor: | Ying Li, Xiao Tang, Rui Wang, Hangyong He, Zhaohui Tong, Xue Yuan, Bing Sun, Hai-Chao Li, Xuyan Li, Chu Huiwen |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_treatment Lung injury Critical Care and Intensive Care Medicine Severity of Illness Index Extracorporeal Membrane Oxygenation medicine Extracorporeal membrane oxygenation Humans Prospective Studies Respiratory system Prospective cohort study Lung Aged Mechanical ventilation Academic Medical Centers Respiratory Distress Syndrome business.industry Middle Aged Respiration Artificial Intensive Care Units medicine.anatomical_structure Anesthesia Breathing Female Inflammation Mediators business Ventilator Weaning Transpulmonary pressure |
| Zdroj: | Critical care medicine. 48(9) |
| ISSN: | 1530-0293 |
| Popis: | Objectives Previous studies have suggested that adjusting ventilator settings based on transpulmonary pressure measurements may minimize ventilator-induced lung injury, but this has never been investigated in patients with severe acute respiratory distress syndrome supported with venovenous extracorporeal membrane oxygenation. We aimed to evaluate whether a transpulmonary pressure-guided ventilation strategy would increase the proportion of patients successfully weaned from venovenous extracorporeal membrane oxygenation support in patients with severe acute respiratory distress syndrome. Design Single-center, prospective, randomized controlled trial. Setting Sixteen-bed, respiratory ICU at a tertiary academic medical center. Patients Severe acute respiratory distress syndrome patients receiving venovenous extracorporeal membrane oxygenation. Interventions One-hundred four patients were randomized to transpulmonary pressure-guided ventilation group (n = 52) or lung rest strategy group (n = 52) groups. Two patients had cardiac arrest during establishment of venovenous extracorporeal membrane oxygenation in the lung rest group did not receive the assigned intervention. Thus, 102 patients were included in the analysis. Measurements and main results The proportion of patients successfully weaned from venovenous extracorporeal membrane oxygenation in the transpulmonary pressure-guided group was significantly higher than that in the lung rest group (71.2% vs 48.0%; p = 0.017). Compared with the lung rest group, driving pressure, tidal volumes, and mechanical power were significantly lower, and positive end-expiratory pressure was significantly higher, in the transpulmonary pressure-guided group during venovenous extracorporeal membrane oxygenation support. In the transpulmonary pressure-guided group, levels of interleukin-1β, interleukin-6, and interleukin-8 were significantly lower, and interleukin-10 was significantly higher, than those of the lung rest group over time. Lung density was significantly lower in the transpulmonary pressure-guided group after venovenous extracorporeal membrane oxygenation support than in the lung rest group. Conclusions A transpulmonary pressure-guided ventilation strategy could increase the proportion of patients with severe acute respiratory distress syndrome successfully weaned from venovenous extracorporeal membrane oxygenation. |
| Databáze: | OpenAIRE |
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