TY - JOUR
T1 - Mechanical Power during Veno-Venous Extracorporeal Membrane Oxygenation Initiation: A Pilot-Study
AU - Belliato, M.
AU - Epis, F.
AU - Cremascoli, L.
AU - Ferrari, F.
AU - Quattrone, M.G.
AU - Fisser, C.
AU - Malfertheiner, M.V.
AU - Taccone, F.S.
AU - Di Nardo, M.
AU - Broman, L.M.
AU - Lorusso, R.
N1 - Funding Information:
The publication fee was supported by Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. The authors would like to thank the staff members of the ICUs involved in this study, who contributed to data sampling and reporting. The authors are grateful to Associate Professor Peter Radell (Pediatric Intensive Care, Astrid Lindgren Children?s Hospital, Karolinska University Hospital, Stockholm, Sweden) for English language editing.
Funding Information:
Funding: The publication fee was supported by Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Institutional Review Board Statement: Not applicable. Informed Consent Statement: Not applicable.
Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Mechanical power (MP) represents a useful parameter to describe and quantify the forces applied to the lungs during mechanical ventilation (MV). In this multi-center, prospective, observational study, we analyzed MP variations following MV adjustments after veno-venous extra-corporeal membrane oxygenation (VV ECMO) initiation. We also investigated whether the MV parameters (including MP) in the early phases of VV ECMO run may be related to the intensive care unit (ICU) mortality. Thirty-five patients with severe acute respiratory distress syndrome were prospectively enrolled and analyzed. After VV ECMO initiation, we observed a significant decrease in median MP (32.4 vs. 8.2 J/min, p < 0.001), plateau pressure (27 vs. 21 cmH(2)O, p = 0.012), driving pressure (11 vs. 8 cmH(2)O, p = 0.014), respiratory rate (RR, 22 vs. 14 breaths/min, p < 0.001), and tidal volume adjusted to patient ideal body weight (V-T/IBW, 5.5 vs. 4.0 mL/kg, p = 0.001) values. During the early phase of ECMO run, RR (17 vs. 13 breaths/min, p = 0.003) was significantly higher, while positive end-expiratory pressure (10 vs. 14 cmH(2)O, p = 0.048) and V-T/IBW (3.0 vs. 4.0 mL/kg, p = 0.028) were lower in ICU non-survivors, when compared to the survivors. The observed decrease in MP after ECMO initiation did not influence ICU outcome. Waiting for large studies assessing the role of these parameters in VV ECMO patients, RR and MP monitoring should not be underrated during ECMO.
AB - Mechanical power (MP) represents a useful parameter to describe and quantify the forces applied to the lungs during mechanical ventilation (MV). In this multi-center, prospective, observational study, we analyzed MP variations following MV adjustments after veno-venous extra-corporeal membrane oxygenation (VV ECMO) initiation. We also investigated whether the MV parameters (including MP) in the early phases of VV ECMO run may be related to the intensive care unit (ICU) mortality. Thirty-five patients with severe acute respiratory distress syndrome were prospectively enrolled and analyzed. After VV ECMO initiation, we observed a significant decrease in median MP (32.4 vs. 8.2 J/min, p < 0.001), plateau pressure (27 vs. 21 cmH(2)O, p = 0.012), driving pressure (11 vs. 8 cmH(2)O, p = 0.014), respiratory rate (RR, 22 vs. 14 breaths/min, p < 0.001), and tidal volume adjusted to patient ideal body weight (V-T/IBW, 5.5 vs. 4.0 mL/kg, p = 0.001) values. During the early phase of ECMO run, RR (17 vs. 13 breaths/min, p = 0.003) was significantly higher, while positive end-expiratory pressure (10 vs. 14 cmH(2)O, p = 0.048) and V-T/IBW (3.0 vs. 4.0 mL/kg, p = 0.028) were lower in ICU non-survivors, when compared to the survivors. The observed decrease in MP after ECMO initiation did not influence ICU outcome. Waiting for large studies assessing the role of these parameters in VV ECMO patients, RR and MP monitoring should not be underrated during ECMO.
KW - acute respiratory distress syndrome
KW - mechanical power
KW - mechanical ventilation
KW - respiratory rate
KW - veno-venous extracorporeal membrane oxygenation
KW - ventilator-induced lung injury
KW - MORTALITY
KW - SURVIVAL
KW - OPEN LUNG CONCEPT
KW - TIDAL VOLUME
KW - PREDICTOR
KW - FAILURE
KW - RESPIRATORY-DISTRESS-SYNDROME
KW - PHYSIOLOGY SCORE II
KW - VENTILATION
KW - DRIVING PRESSURE
U2 - 10.3390/membranes11010030
DO - 10.3390/membranes11010030
M3 - Article
C2 - 33401668
SN - 2077-0375
VL - 11
JO - Membranes
JF - Membranes
IS - 1
M1 - 30
ER -