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

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.
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Zdroj: Intensive Care Medicine
ISSN: 1432-1238
0342-4642
Popis: 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. Electronic supplementary material The online version of this article (doi:10.1007/s00134-016-4507-0) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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