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

PeerJ

article

Ting-Yu Liao¹  Sheng-Yuan Ruan²  Chien-Heng Lai³  Li-Jung Tseng³  Li-Ta Keng¹  You-Yi Chen⁴  Chih-Hsien Wang³  Jung-Yien Chien²  Huey-Dong Wu²  Yih-Sharng Chen³  Chong-Jen Yu¹ 

[1]Departments of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch

[2]Departments of Internal Medicine, National Taiwan University Hospital

[3]Department of Surgery, National Taiwan University Hospital

[4]Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch

[5]Thoracic Medicine Center, Department of Medicine and Surgery, National Taiwan University Hospital Yunlin Branch

关键词: Extracorporeal membrane oxygenation;    Influenza;    Acute respiratory distress syndrome;   

DOI  :  10.7717/peerj.14140

学科分类：社会科学、人文和艺术（综合）

来源: Inra

【 摘 要 】

BackgroundPatients 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.MethodsThis 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.Results24 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, p12 breaths/min was still associated with higher mortality (adjusted hazard ratio = 3.31, 95% confidence interval = 1.10–9.97, p = 0.034).ConclusionsIn 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.

【 授权许可】

CC BY