Early Driving Pressure Changes Predict Outcomes during Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome.
Journal
Critical care research and practice
ISSN: 2090-1305
Titre abrégé: Crit Care Res Pract
Pays: Egypt
ID NLM: 101539357
Informations de publication
Date de publication:
2020
2020
Historique:
received:
30
11
2019
revised:
23
01
2020
accepted:
11
02
2020
entrez:
8
4
2020
pubmed:
8
4
2020
medline:
8
4
2020
Statut:
epublish
Résumé
Extracorporeal membrane oxygenation (ECMO) serves as a rescue therapy when systemic hypoxia persists despite conventional care for severe acute respiratory distress syndrome (ARDS). Due to the extracorporeal gas exchange, the Between December 2014 and May 2018, 105 patients underwent venovenous ECMO in our institution. From these patients, we identified 28 who died during ECMO therapy and assigned 28 control patients using propensity score matching based on the following criteria: age, ARDS severity, and SAPSII score at admission. A statistical evaluation of the patient characteristics, intensive care data, morbidities, respiratory system variables, and outcomes was performed. The baseline patient characteristics did not differ between groups and ECMO was placed on day 1 in all patients. The analyzed variables of respiratory mechanics, such as the plateau pressure, positive end-expiratory pressure, and tidal volume, did not differ between groups. The driving pressure before ECMO was equal between the nonsurvivors and the controls. Twelve hours after initiation of ECMO therapy, the driving pressure decreased by 40.8% in the survivors but by only 20.1% in the nonsurvivors. We report that very early driving pressure changes can serve as an indicator of disease severity and predict patient survival following ECMO therapy.
Sections du résumé
BACKGROUND
BACKGROUND
Extracorporeal membrane oxygenation (ECMO) serves as a rescue therapy when systemic hypoxia persists despite conventional care for severe acute respiratory distress syndrome (ARDS). Due to the extracorporeal gas exchange, the
RESULTS
RESULTS
Between December 2014 and May 2018, 105 patients underwent venovenous ECMO in our institution. From these patients, we identified 28 who died during ECMO therapy and assigned 28 control patients using propensity score matching based on the following criteria: age, ARDS severity, and SAPSII score at admission. A statistical evaluation of the patient characteristics, intensive care data, morbidities, respiratory system variables, and outcomes was performed. The baseline patient characteristics did not differ between groups and ECMO was placed on day 1 in all patients. The analyzed variables of respiratory mechanics, such as the plateau pressure, positive end-expiratory pressure, and tidal volume, did not differ between groups. The driving pressure before ECMO was equal between the nonsurvivors and the controls. Twelve hours after initiation of ECMO therapy, the driving pressure decreased by 40.8% in the survivors but by only 20.1% in the nonsurvivors.
CONCLUSIONS
CONCLUSIONS
We report that very early driving pressure changes can serve as an indicator of disease severity and predict patient survival following ECMO therapy.
Identifiants
pubmed: 32257436
doi: 10.1155/2020/6958152
pmc: PMC7085355
doi:
Types de publication
Journal Article
Langues
eng
Pagination
6958152Informations de copyright
Copyright © 2020 Harry Magunia et al.
Déclaration de conflit d'intérêts
The authors declare that they have no conflicts of interest regarding the publication of this paper.
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