Definition and management of right ventricular injury in adult patients receiving extracorporeal membrane oxygenation for respiratory support using the Delphi method: a PRORVnet study. Expert position statements.
ARDS
ECMO
Extracorporeal membrane oxygenation
Respiratory failure
Right ventricular failure
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
05 Aug 2024
05 Aug 2024
Historique:
received:
13
04
2024
accepted:
05
07
2024
medline:
5
8
2024
pubmed:
5
8
2024
entrez:
5
8
2024
Statut:
aheadofprint
Résumé
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an integral part of the management algorithm of patients with severe respiratory failure refractory to evidence-based conventional treatments. Right ventricular injury (RVI) pertaining to abnormalities in the dimensions and/or function of the right ventricle (RV) in the context of VV-ECMO significantly influences mortality. However, in the absence of a universally accepted RVI definition and evidence-based guidance for the management of RVI in this very high-risk patient cohort, variations in clinical practice continue to exist. Following a systematic search of the literature, an international Steering Committee consisting of eight healthcare professionals involved in the management of patients receiving ECMO identified domains and knowledge gaps pertaining to RVI definition and management where the evidence is limited or ambiguous. Using a Delphi process, an international panel of 52 Experts developed Expert position statements in those areas. The process also conferred RV-centric overarching open questions for future research. Consensus was defined as achieved when 70% or more of the Experts agreed or disagreed on a Likert-scale statement or when 80% or more of the Experts agreed on a particular option in multiple-choice questions. The Delphi process was conducted through four rounds and consensus was achieved on 31 (89%) of 35 statements from which 24 Expert position statements were derived. Expert position statements provided recommendations for RVI nomenclature in the setting of VV-ECMO, a multi-modal diagnostic approach to RVI, the timing and parameters of diagnostic echocardiography, and VV-ECMO settings during RVI assessment and management. Consensus was not reached on RV-protective driving pressure thresholds or the effect of prone positioning on patient-centric outcomes. The proposed definition of RVI in the context of VV-ECMO needs to be validated through a systematic aggregation of data across studies. Until further evidence emerges, the Expert position statements can guide informed decision-making in the management of these patients.
Identifiants
pubmed: 39102027
doi: 10.1007/s00134-024-07551-z
pii: 10.1007/s00134-024-07551-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Cara Agerstrand
(C)
Bindu Akkanti
(B)
Jenelle Badulak
(J)
Antoine Vieillard-Baron
(A)
Thomas V Brogan
(TV)
Daniel Brodie
(D)
Michael Cain
(M)
Luigi Camporota
(L)
Alain Combes
(A)
William Cornwell
(W)
Dirk W Donker
(DW)
Ghislaine Douflé
(G)
Eddy Fan
(E)
Simon Finney
(S)
Jumana Yusuf Haji
(JY)
Paul M Hassoun
(PM)
Anna Hemnes
(A)
Graziella Isgro
(G)
Nicola Jones
(N)
David Joyce
(D)
Christian Karagiannidis
(C)
Maziar Khorsandi
(M)
Tim Lahm
(T)
Chiara Lazzeri
(C)
Stephane Ledot
(S)
David Levy
(D)
Andreas Liliequist
(A)
Hoong Sern Lim
(HS)
Graeme MacLaren
(G)
Marc O Maybauer
(MO)
Priya Nair
(P)
Chris Nickson
(C)
Anton Vonk Noordegraaf
(AV)
Ken Parhar
(K)
Giles Peek
(G)
Tommaso Pettenuzzo
(T)
Michael R Pinsky
(MR)
Susanna Price
(S)
Nida Qadir
(N)
Matthew Read
(M)
Ben Shelley
(B)
Mark S Slaughter
(MS)
Douglas Slobod
(D)
Andrej Šribar
(A)
Justyna Swol
(J)
Joseph E Tonna
(JE)
Asad Usman
(A)
Kamen Valchanov
(K)
Corey Ventetuolo
(C)
Alain Vuylsteke
(A)
Akram Zaaqoq
(A)
Bishoy Zakhary
(B)
Informations de copyright
© 2024. Crown.
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