Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Oct;6(19):386.
doi: 10.21037/atm.2018.10.11.

Mechanical ventilation and respiratory monitoring during extracorporeal membrane oxygenation for respiratory support

Nicolò Patroniti  1   2 , Giulia Bonatti  2 , Tarek Senussi  2 , Chiara Robba  1
Affiliations
Review

Mechanical ventilation and respiratory monitoring during extracorporeal membrane oxygenation for respiratory support

Nicolò Patroniti et al. Ann Transl Med. 2018 Oct.

Abstract

Over the past decade, the use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) for respiratory support has widely expanded as a treatment strategy for patients with acute respiratory distress syndrome (ARDS). Despite considerable attention has been given to the indications, the timing and the management of patients undergoing ECMO for refractory respiratory hypoxemic failure, little is known regarding the management of mechanical ventilation (MV) in this group of patients. ECMO enables to minimize ventilatory induced lung injury (VILI) and it has been successfully used as rescue therapy in patients with ARDS when conventional ventilator strategies have failed. However, literature is lacking regarding the best strategies and MV settings, including positive end expiratory pressure (PEEP), tidal volume (VT), respiratory rate (RR) and plateau pressure (PPLAT). The aim of this review is to summarize current evidence, the rationale and provide recommendations about the best ventilator strategy to adopt in patients with ARDS undergoing VV-ECMO support.

Keywords: Mechanical ventilation (MV); acute respiratory distress syndrome (ARDS); extracorporeal membrane oxygenation (ECMO); positive end expiratory pressure (PEEP).

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
A flow chart of ventilator settings after ECMO starting. Sequence of setting changes follow literature common procedure. Tidal volume (VT) is decrease targeting a safe plateau airway pressure or targeting a predefined VT value (ultra-protective ventilation). After adjusting VT, respiratory rate (RR) may be changed according to PaCO2/pH or target to a fixed low level (5–10 bpm). Decrease of VT and RR are allowed by CO2 removal mainly modulated by acting on sweep gas flow (GF). This is feasible both with ECMO or ECCO2R. When high ECMO blood flows (BF) are used, oxygenation is supported, and FiO2 may be decreased. PEEP may either be decreased if a total lung rest strategy is used, or may be set to avoid derecruitment associated to low VT ventilation (black dotted line). ↓, decrease; ↑, increase. ECMO, extracorporeal membrane oxygenation.
See this image and copyright information in PMC

References

    1. Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med 2011;365:1905-14. 10.1056/NEJMct1103720 - DOI - PubMed
    1. ARDS Definition Task Force , Ranieri V, Rubenfeld G, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307:2526-33. - PubMed
    1. Hill JD, O’Brien TG, Murray JJ, et al. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med 1972;286:629-34. 10.1056/NEJM197203232861204 - DOI - PubMed
    1. Lee JJ, Hwang SM, Ko JH, et al. Efficacy of veno-venous extracorporeal membrane oxygenation in severe acute respiratory failure. Yonsei Med J 2015;56:212-9. 10.3349/ymj.2015.56.1.212 - DOI - PMC - PubMed
    1. Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009;374:1351-63. 10.1016/S0140-6736(09)61069-2 - DOI - PubMed