Mechanical Ventilation for Acute Respiratory Distress Syndrome during Extracorporeal Life Support. Research and Practice
Darryl Abrams
(1, 2)
,
Matthieu Schmidt
(3, 4)
,
Tài Pham
(5, 6, 7)
,
Jeremy Beitler
(1, 2)
,
Eddy Fan
(5, 8)
,
Ewan Goligher
(5, 8)
,
James Mcnamee
(9, 10)
,
Nicolò Patroniti
(11, 12)
,
M. Elizabeth Wilcox
(5, 8)
,
Alain Combes
(3, 4)
,
Niall Ferguson
(5, 8)
,
Danny Mcauley
(9, 10)
,
Antonio Pesenti
(13, 14)
,
Michael Quintel
(15)
,
John Fraser
(16, 17)
,
Carol Hodgson
(18)
,
Catherine Hough
(19)
,
Alain Mercat
(20, 21)
,
Thomas Mueller
(22)
,
Vin Pellegrino
(23)
,
V. Marco Ranieri
(24)
,
Kathy Rowan
(25)
,
Kiran Shekar
(16, 17)
,
Laurent Brochard
(5, 6)
,
Daniel Brodie
(1, 2)
1
Columbia University College of Physicians and Surgeons
2 CUMC - Columbia University Medical Center
3 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
4 Institut de cardiologie [CHU Pitié-Salpêtrière]
5 University of Toronto
6 St. Michael's Hospital
7 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
8 University Health Network [Toronto, ON, Canada]
9 QUB - Queen's University [Belfast]
10 Royal Victoria Hospital
11 IRCCS Istituto Giannina Gaslini [Genoa, Italy]
12 UniGe - Università degli studi di Genova = University of Genoa
13 UNIMI - Università degli Studi di Milano = University of Milan
14 Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
15 Georg-August-University = Georg-August-Universität Göttingen
16 The Prince Charles Hospital
17 UQ [All campuses : Brisbane, Dutton Park Gatton, Herston, St Lucia and other locations] - The University of Queensland
18 Monash University [Melbourne]
19 University of Washington [Seattle]
20 CHU Angers - Centre Hospitalier Universitaire d'Angers
21 UA - Université d'Angers
22 University Hospital Regensburg
23 The Alfred Hospital
24 UNIBO - Alma Mater Studiorum Università di Bologna = University of Bologna
25 Clinical Trials Unit, Intensive Care National Audit and Research Centre (ICNARC), London
2 CUMC - Columbia University Medical Center
3 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
4 Institut de cardiologie [CHU Pitié-Salpêtrière]
5 University of Toronto
6 St. Michael's Hospital
7 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
8 University Health Network [Toronto, ON, Canada]
9 QUB - Queen's University [Belfast]
10 Royal Victoria Hospital
11 IRCCS Istituto Giannina Gaslini [Genoa, Italy]
12 UniGe - Università degli studi di Genova = University of Genoa
13 UNIMI - Università degli Studi di Milano = University of Milan
14 Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
15 Georg-August-University = Georg-August-Universität Göttingen
16 The Prince Charles Hospital
17 UQ [All campuses : Brisbane, Dutton Park Gatton, Herston, St Lucia and other locations] - The University of Queensland
18 Monash University [Melbourne]
19 University of Washington [Seattle]
20 CHU Angers - Centre Hospitalier Universitaire d'Angers
21 UA - Université d'Angers
22 University Hospital Regensburg
23 The Alfred Hospital
24 UNIBO - Alma Mater Studiorum Università di Bologna = University of Bologna
25 Clinical Trials Unit, Intensive Care National Audit and Research Centre (ICNARC), London
Résumé
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 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.