Abrams, Darryl and Schmidt, Matthieu and Tai Pham, and Beitler, Jeremy R. and Fan, Eddy and Goligher, Ewan C. and McNamee, James J. and Patroniti, Nicolo and Wilcox, M. Elizabeth and Combes, Alain and Ferguson, Niall D. and McAuley, Danny F. and Pesenti, Antonio and Quintel, Michael and Fraser, John and Hodgson, Carol L. and Hough, Catherine L. and Mercat, Alain and Mueller, Thomas and Pellegrino, Vin and Ranieri, V. Marco and Rowan, Kathy and Shekar, Kiran and Brochard, Laurent and Brodie, Daniel (2020) Mechanical Ventilation for Acute Respiratory Distress Syndrome during Extracorporeal Life Support Research and Practice. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 201 (5). pp. 514-525. ISSN 1073-449X, 1535-4970
Full text not available from this repository. (Request a copy)Abstract
Ventilator-induced lung injury remains a key contributor to the morbidity and mortality of acute respiratory distress syndrome (ARDS). Efforts to minimize 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 V-T 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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ACUTE LUNG INJURY; END-EXPIRATORY PRESSURE; MEMBRANE-OXYGENATION; ADULT PATIENTS; PROTECTIVE VENTILATION; DRIVING PRESSURE; TIDAL VOLUMES; CO-2 REMOVAL; CO2 REMOVAL; 6 ML/KG; acute respiratory distress syndrome; extracorporeal life support; extracorporeal membrane oxygenation; extracorporeal carbon dioxide removal; ventilator-induced lung injury |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Petra Gürster |
| Date Deposited: | 08 Apr 2021 07:50 |
| Last Modified: | 08 Apr 2021 07:50 |
| URI: | https://pred.uni-regensburg.de/id/eprint/45029 |
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