Mechanical ventilation for acute respiratory distress syndrome during extracorporeal life support research and practice

Darryl Abrams, Matthieu Schmidt, Tái Pham, Jeremy R. Beitler, Eddy Fan, Ewan C. Goligher, James J. McNamee, Nicoló Patroniti, M. Elizabeth Wilcox, Alain Combes, Niall D. Ferguson, Danny F. McAuley, Antonio Pesenti, Michael Quintel, John Fraser, Carol L. Hodgson, Catherine L. Hough, Alain Mercat, Thomas Mueller, Vin PellegrinoV. Marco Ranieri, Kathy Rowan, Kiran Shekar, Laurent Brochard, Daniel Brodie

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations

Abstract

Ventilator-induced lung injury remains a key contributor to the morbidity and mortality of acute respiratory distress syndrome (ARDS). Efforts tominimize this injury are typically limited by the need to preserve adequate gas exchange. In the most severe forms of the syndrome, extracorporeal life support is increasingly being deployed for severe hypoxemia or hypercapnic acidosis refractory to conventional ventilator management strategies. Data from a recent randomized controlled trial, a post hoc analysis of that trial, a meta-analysis, and a large international multicenter observational study suggest that extracorporeal life support, when combined with lower VT and airway pressures than the current standard of care, may improve outcomes compared with conventional management in patients with the most severe forms of ARDS. These findings raise important questions not only about the optimal ventilation strategies for patients receiving extracorporeal support but also regarding how various mechanisms of lung injury in ARDS may potentially be mitigated by ultra-lung-protective ventilation strategies when gas exchange is sufficiently managed with the extracorporeal circuit. Additional studies are needed to more precisely delineate the best strategies for optimizing invasive mechanical ventilation in this patient population.

Original languageEnglish (US)
Pages (from-to)514-525
Number of pages12
JournalAmerican journal of respiratory and critical care medicine
Volume201
Issue number5
DOIs
StatePublished - Mar 1 2020
Externally publishedYes

Keywords

  • Acute respiratory distress syndrome
  • Extracorporeal carbon dioxide removal
  • Extracorporeal life support
  • Extracorporeal membrane oxygenation
  • Ventilator-induced lung injury

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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