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Multicenter Study
. 2022 Oct 10:10:e14140.
doi: 10.7717/peerj.14140. eCollection 2022.

Impact of ventilator settings during venovenous extracorporeal membrane oxygenation on clinical outcomes in influenza-associated acute respiratory distress syndrome: a multicenter retrospective cohort study

Ting-Yu Liao  1 , Sheng-Yuan Ruan  2 , Chien-Heng Lai  3 , Li-Jung Tseng  3 , Li-Ta Keng  1 , You-Yi Chen  4   5 , Chih-Hsien Wang  3 , Jung-Yien Chien  2 , Huey-Dong Wu  2 , Yih-Sharng Chen  3 , Chong-Jen Yu  1   2 ; TACTICS Study Group
Affiliations
Multicenter Study

Impact of ventilator settings during venovenous extracorporeal membrane oxygenation on clinical outcomes in influenza-associated acute respiratory distress syndrome: a multicenter retrospective cohort study

Ting-Yu Liao et al. PeerJ. .

Abstract

Background: Patients with influenza-associated acute respiratory distress syndrome (ARDS) requiring venovenous extracorporeal membrane oxygenation (vv-ECMO) support have a high mortality rate. Ventilator settings have been known to have a substantial impact on outcomes. However, the optimal settings of mechanical ventilation during vv-ECMO are still unknown.

Methods: This multicenter retrospective cohort study was conducted in the intensive care units (ICUs) of three tertiary referral hospitals in Taiwan between July 2009 and December 2019. It aims to describe the effect of ventilator settings during vv-ECMO on patient outcomes.

Results: A total of 93 patients with influenza receiving ECMO were screened. Patients were excluded if they: were receiving venoarterial ECMO, died within three days of vv-ECMO initiation, or were transferred to the tertiary referral hospital >24 hours after vv-ECMO initiation. A total of 62 patients were included in the study, and 24 (39%) died within six months. During the first three days of ECMO, there were no differences in tidal volume (5.1 vs. 5.2 mL/kg, p = 0.833), dynamic driving pressure (15 vs. 14 cmH2O, p = 0.146), and mechanical power (11.3 vs. 11.8 J/min, p = 0.352) between survivors and non-survivors. However, respiratory rates were significantly higher in non-survivors compared with survivors (15 vs. 12 breaths/min, p = 0.013). After adjustment for important confounders, a higher mean respiratory rate of >12 breaths/min was still associated with higher mortality (adjusted hazard ratio = 3.31, 95% confidence interval = 1.10-9.97, p = 0.034).

Conclusions: In patients with influenza-associated ARDS receiving vv-ECMO support, we found that a higher respiratory rate was associated with higher mortality. Respiratory rate might be a modifiable factor to improve outcomes in this patient population.

Keywords: Acute respiratory distress syndrome; Extracorporeal membrane oxygenation; Influenza.

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Conflict of interest statement

The authors declare there are no competing interests.

Figures

Figure 1
Figure 1. Flow chart depicting the study design.
ARDS, acute respiratory distress syndrome; ECMO, extracorporeal membrane oxygenation.
Figure 2
Figure 2. Box-plot of mean tidal volume per predicted body weight (A), mean respiratory rate (B), mean mean airway pressure (C), mean positive end-expiratory pressure (D), mean dynamic driving pressure (E), and mean mechanical power (F) from day 1 to day 3 after venovenous extracorporeal membrane oxygenation (vv-ECMO) support according to the six-month outcome.
Figure 3
Figure 3. Kaplan–Meier plot and log-rank test for six-month survival according to respiratory rate (RR) (A), tidal volume (TV) and dynamic driving pressure (B) during the first 3 days after venovenous extracorporeal membrane oxygenation (vv-ECMO) initiation.
Figure 4
Figure 4. Distribution of respiratory rate versus tidal volume during the first 3 days after venovenous extracorporeal membrane oxygenation (vv-ECMO) support for each patient. Twenty five patients (mortality 16%) fell within the limits, which defined as respiratory rate ≦12 breaths/min.
See this image and copyright information in PMC

References

    1. Abrams D, Schmidt M, Pham T, Beitler JR, Fan E, Goligher EC, McNamee JJ, Patroniti N, Wilcox ME, Combes A, Ferguson ND, McAuley DF, Pesenti A, Quintel M, Fraser J, Hodgson CL, Hough CL, Mercat A, Mueller T, Pellegrino V, Ranieri VM, Rowan K, Shekar K, Brochard L, Brodie D. Mechanical ventilation for acute respiratory distress syndrome during extracorporeal life support. Research and Practice. American Journal of Respiratory and Critical Care Medicine. 2020;201:514–525. doi: 10.1164/rccm.201907-1283CI. - DOI - PubMed
    1. Araos J, Alegria L, Garcia P, Cruces P, Soto D, Erranz B, Amthauer M, Salomon T, Medina T, Rodriguez F, Ayala P, Borzone GR, Meneses M, Damiani F, Retamal J, Cornejo R, Bugedo G, Bruhn A. Near-apneic ventilation decreases lung injury and fibroproliferation in an acute respiratory distress syndrome model with extracorporeal membrane oxygenation. American Journal of Respiratory and Critical Care Medicine. 2019;199:603–612. doi: 10.1164/rccm.201805-0869OC. - DOI - PubMed
    1. Becher T, Van der Staay M, Schadler D, Frerichs I, Weiler N. Calculation of mechanical power for pressure-controlled ventilation. Intensive Care Medicine. 2019;45:1321–1323. doi: 10.1007/s00134-019-05636-8. - DOI - PubMed
    1. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. American Journal of Respiratory and Critical Care Medicine. 1994;149:818–824. doi: 10.1164/ajrccm.149.3.7509706. - DOI - PubMed
    1. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. International Journal of Chronic Diseases. 1987;40:373–383. doi: 10.1016/0021-9681(87)90171-8. - DOI - PubMed

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