Mechanical ventilation during extracorporeal membrane oxygenation. An international survey
RATIONALE: In patients with severe, acute respiratory failure undergoing venovenous extracorporeal membrane oxygenation (VV-ECMO), the optimal strategy for mechanical ventilation is unclear.
OBJECTIVES: Our objective was to describe ventilation practices used in centers registered with the Extracorporeal Life Support Organization (ELSO).
METHODS: We conducted an international cross-sectional survey of medical directors and ECMO program coordinators from all ELSO-registered centers. The survey was distributed using a commercial website that collected information on center characteristics, the presence of a mechanical ventilator protocol, ventilator settings, and weaning practices. E-mails were sent out to medical directors or coordinators at each ELSO center and their responses were pooled for analysis.
MEASUREMENTS AND MAIN RESULTS: We analyzed 141 (50%) individual responses from the 283 centers contacted across 28 countries. Only 27% of centers reported having an explicit mechanical ventilation protocol for ECMO patients. The majority of these centers (77%) reported "lung rest" to be the primary goal of mechanical ventilation, whereas 9% reported "lung recruitment" to be their ventilation strategy. A tidal volume of 6 ml/kg or less was targeted by 76% of respondents, and 58% targeted a positive end-expiratory pressure of 6-10 cm H2O while ventilating patients on VV-ECMO. Centers prioritized weaning VV-ECMO before mechanical ventilation.
CONCLUSIONS: Although ventilation practices in patients supported by VV-ECMO vary across ELSO centers internationally, the majority of centers used a strategy that targeted lung-protective thresholds and prioritized weaning VV-ECMO over mechanical ventilation.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2014 |
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| Erschienen: |
2014 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:11 |
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| Enthalten in: |
Annals of the American Thoracic Society - 11(2014), 6 vom: 13. Juli, Seite 956-61 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Marhong, Jonathan D [VerfasserIn] |
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| Links: |
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| Themen: |
Acute respiratory distress syndrome |
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| Anmerkungen: |
Date Completed 14.04.2015 Date Revised 09.12.2020 published: Print Citation Status MEDLINE |
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| doi: |
10.1513/AnnalsATS.201403-100BC |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM239703715 |
|---|
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| 245 | 1 | 0 | |a Mechanical ventilation during extracorporeal membrane oxygenation. An international survey |
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| 500 | |a Date Completed 14.04.2015 | ||
| 500 | |a Date Revised 09.12.2020 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a RATIONALE: In patients with severe, acute respiratory failure undergoing venovenous extracorporeal membrane oxygenation (VV-ECMO), the optimal strategy for mechanical ventilation is unclear | ||
| 520 | |a OBJECTIVES: Our objective was to describe ventilation practices used in centers registered with the Extracorporeal Life Support Organization (ELSO) | ||
| 520 | |a METHODS: We conducted an international cross-sectional survey of medical directors and ECMO program coordinators from all ELSO-registered centers. The survey was distributed using a commercial website that collected information on center characteristics, the presence of a mechanical ventilator protocol, ventilator settings, and weaning practices. E-mails were sent out to medical directors or coordinators at each ELSO center and their responses were pooled for analysis | ||
| 520 | |a MEASUREMENTS AND MAIN RESULTS: We analyzed 141 (50%) individual responses from the 283 centers contacted across 28 countries. Only 27% of centers reported having an explicit mechanical ventilation protocol for ECMO patients. The majority of these centers (77%) reported "lung rest" to be the primary goal of mechanical ventilation, whereas 9% reported "lung recruitment" to be their ventilation strategy. A tidal volume of 6 ml/kg or less was targeted by 76% of respondents, and 58% targeted a positive end-expiratory pressure of 6-10 cm H2O while ventilating patients on VV-ECMO. Centers prioritized weaning VV-ECMO before mechanical ventilation | ||
| 520 | |a CONCLUSIONS: Although ventilation practices in patients supported by VV-ECMO vary across ELSO centers internationally, the majority of centers used a strategy that targeted lung-protective thresholds and prioritized weaning VV-ECMO over mechanical ventilation | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Extracorporeal Life Support Organization | |
| 650 | 4 | |a acute respiratory distress syndrome | |
| 650 | 4 | |a extracorporeal membrane oxygenation | |
| 650 | 4 | |a international survey | |
| 650 | 4 | |a mechanical ventilation | |
| 700 | 1 | |a Telesnicki, Teagan |e verfasserin |4 aut | |
| 700 | 1 | |a Munshi, Laveena |e verfasserin |4 aut | |
| 700 | 1 | |a Del Sorbo, Lorenzo |e verfasserin |4 aut | |
| 700 | 1 | |a Detsky, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Fan, Eddy |e verfasserin |4 aut | |
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