TY - JOUR
T1 - Mechanical power during veno-venous extracorporeal membrane oxygenation initiation
T2 - A pilot-study
AU - Belliato, Mirko
AU - Epis, Francesco
AU - Cremascoli, Luca
AU - Ferrari, Fiorenza
AU - Quattrone, Maria Giovanna
AU - Fisser, Christoph
AU - Malfertheiner, Maximilian Valentin
AU - Taccone, Fabio Silvio
AU - Di Nardo, Matteo
AU - Broman, Lars Mikael
AU - Lorusso, Roberto
N1 - 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.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
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 cmH2O, p = 0.012), driving pressure (11 vs. 8 cmH2O, p = 0.014), respiratory rate (RR, 22 vs. 14 breaths/min, p < 0.001), and tidal volume adjusted to patient ideal body weight (VT/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 cmH2O, p = 0.048) and VT/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 cmH2O, p = 0.012), driving pressure (11 vs. 8 cmH2O, p = 0.014), respiratory rate (RR, 22 vs. 14 breaths/min, p < 0.001), and tidal volume adjusted to patient ideal body weight (VT/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 cmH2O, p = 0.048) and VT/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
UR - http://www.scopus.com/inward/record.url?scp=85099031667&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85099031667&partnerID=8YFLogxK
U2 - 10.3390/membranes11010030
DO - 10.3390/membranes11010030
M3 - Article
AN - SCOPUS:85099031667
VL - 11
SP - 1
EP - 11
JO - Membranes
JF - Membranes
SN - 2077-0375
IS - 1
M1 - 30
ER -