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26-07-2023 | ECMO | RESEARCH

Association between pediatric intensive care mortality and mechanical ventilation settings during extracorporeal membrane oxygenation for pediatric acute respiratory distress syndrome

Authors: Jerome Rambaud, Lars M. Broman, Sylvie Chevret, Federico Visconti, Pierre-Louis Leger, Yigit Guner, Laura Butragueño-Laiseca, Jean-eudes Piloquet, Matteo Di Nardo

Published in: European Journal of Pediatrics | Issue 10/2023

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Abstract

The main objective of this study was to describe the current mechanical ventilation (MV) settings during extracorporeal membrane oxygenation (ECMO) for pediatric acute respiratory distress syndrome (P-ARDS) in six European centers. This is a retrospective observational cohort study performed in six European centers from January 2009 to December 2019. Children > 1 month to 18 years supported with ECMO for refractory P-ARDS were included. Collected data were as follows: patients’ pre-ECMO medical condition, pre-ECMO adjunctive therapies for P-ARDS, pre-ECMO and during ECMO MV settings on day (D) 1, D3, D7, and D14 of ECMO, use of adjunctive therapies during ECMO, duration of ECMO, pediatric intensive care unit length of stay, and survival. A total of 255 patients with P-ARDS were included. The multivariate analysis showed that PEEP on D1 (OR = 1.13, 95% CI [1.03–1.24], p = 0.01); D3 (OR = 1.17, 95% CI [1.06–1.29], p = 0.001); and D14 (OR = 1.21, 95% CI [1.05–1.43], p = 0.02) and DP on D7 were significantly associated with higher odds of mortality (OR = 0.82, 95% CI [0.71–0.92], p = 0.001). Moreover, DP on D1 above 15 cmH2O (OR 2.23, 95% CI (1.09–4.71), p = 0.03) and native lung FiO2 above 60% on D14 (OR 10.36, 95% CI (1.51–116.15), p = 0.03) were significantly associated with higher odds of mortality.
   Conclusion: MV settings during ECMO for P-ARDS varied among centers; however, use of high PEEP levels during ECMO was associated with higher odds of mortality as well as a DP above 15 cmH2O and a native lung FiO2 above 60% on D14 of ECMO.
What is Known:
• Invasive ventilation settings are well defined for pediatric acute respiratory distress syndrome; however, once the children required an extracorporeal respiratory support, there is no recommendation how to set the mechanical ventilator.
• Impact of invasive ventilator during extracorporeal respiratory support ad only been during the first days of this support but the effects of these settings later in the assistance are not described.
What is New:
• It seems to be essential to early decrease FiO2 on native lung once the ECMO flow allows an efficient oxygenation.
• Tight control to limit the driving pressure at 15 cmH20 during ECMO run seems to be associated with better survival rate.
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Metadata
Title
Association between pediatric intensive care mortality and mechanical ventilation settings during extracorporeal membrane oxygenation for pediatric acute respiratory distress syndrome
Authors
Jerome Rambaud
Lars M. Broman
Sylvie Chevret
Federico Visconti
Pierre-Louis Leger
Yigit Guner
Laura Butragueño-Laiseca
Jean-eudes Piloquet
Matteo Di Nardo
Publication date
26-07-2023
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Pediatrics / Issue 10/2023
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-023-05119-5

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