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Intensive Care Medicine

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01-06-2015 | Systematic Review

Mechanical ventilation during extracorporeal life support (ECLS): a systematic review

Authors: Jonathan D. Marhong, Laveena Munshi, Michael Detsky, Teagan Telesnicki, Eddy Fan

Published in: Intensive Care Medicine | Issue 6/2015

Abstract

Purpose

In patients with acute respiratory distress syndrome (ARDS), extracorporeal life support (ECLS) has been utilized to support gas exchange and mitigate ventilator-induced lung injury (VILI). The optimal ventilation settings while on ECLS are unknown. The purpose of this systematic review is to describe the ventilation practices in patients with ARDS who require ECLS.

Methods

We electronically searched MEDLINE, EMBASE, CENTRAL, AMED, and HAPI (inception to January 2015). Studies included were randomized controlled trials, observational studies, or case series (≥4 patients) of ARDS patients undergoing ECLS. Our review focused on studies describing ventilation practices employed during ECLS for ARDS.

Results

Forty-nine studies (2,042 patients) met our inclusion criteria. Prior to initiation of ECLS, at least one parameter consistent with injurious ventilation [tidal volume >8 mL/kg predicted body weight (PBW), peak pressure >35 cmH₂O (or plateau pressure >30 cmH₂O), or FiO₂ ≥0.8] was noted in 90 % of studies. After initiation of ECLS, studies reported median [interquartile range (IQR)] reductions in: tidal volume [2.4 mL/kg PBW (2.2–2.9)], plateau pressure [4.3 cmH₂O (3.5–5.8)], positive end-expiratory pressure (PEEP) [0.20 cmH₂O (0–3.0)], and FiO₂ [0.40 (0.30–0.60)]. Median (IQR) overall mortality was 41 % (31–51 %).

Conclusions

Reduction in the intensity of mechanical ventilation in patients with ARDS supported by ECLS is common, suggesting that clinicians may be focused on reducing VILI after ECLS initiation. Future investigations should focus on establishing the optimal ventilatory strategy for patients with ARDS who require ECLS.

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Title: Mechanical ventilation during extracorporeal life support (ECLS): a systematic review
Authors: Jonathan D. Marhong
Laveena Munshi
Michael Detsky
Teagan Telesnicki
Eddy Fan
Publication date: 01-06-2015
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 6/2015
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-015-3716-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Mechanical ventilation during extracorporeal life support (ECLS): a systematic review

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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