PMID- 29221484 OWN - NLM STAT- MEDLINE DCOM- 20180724 LR - 20201209 IS - 1471-2466 (Electronic) IS - 1471-2466 (Linking) VI - 17 IP - 1 DP - 2017 Dec 8 TI - The impacts of baseline ventilator parameters on hospital mortality in acute respiratory distress syndrome treated with venovenous extracorporeal membrane oxygenation: a retrospective cohort study. PG - 181 LID - 10.1186/s12890-017-0520-5 [doi] LID - 181 AB - BACKGROUND: Venovenous extracorporeal membrane oxygenation (VV-ECMO) is a valuable life support in acute respiratory distress syndrome (ARDS) in adult patients. However, the success of VV-ECMO is known to be influenced by the baseline settings of mechanical ventilation (MV) before its institution. This study was aimed at identifying the baseline ventilator parameters which were independently associated with hospital mortality in non-trauma patients receiving VV-ECMO for severe ARDS. METHODS: This retrospective study included 106 non-trauma patients (mean age: 53 years) who received VV-ECMO for ARDS in a single medical center from 2007 to 2016. The indication of VV-ECMO was severe hypoxemia (P(a)O(2)/ FiO(2) ratio < 70 mmHg) under pressure-controlled MV with peak inspiratory pressure (PIP) > 35 cmH(2)O, positive end-expiratory pressure (PEEP) > 5 cmH(2)O, and F(i)O(2) > 0.8. Important demographic and clinical data before and during VV-ECMO were collected for analysis of hospital mortality. RESULTS: The causes of ARDS were bacterial pneumonia (n = 41), viral pneumonia (n = 24), aspiration pneumonitis (n = 3), and others (n = 38). The median duration of MV before ECMO institution was 3 days and the overall hospital mortality was 53% (n = 56). The medians of PaO(2)/ FiO(2) ratio, PIP, PEEP, and dynamic pulmonary compliance (PC(dyn)) at the beginning of MV were 84 mmHg, 32 cmH(2)O, 10 cmH(2)O, and 21 mL/cmH(2)O, respectively. However, before the beginning of VV-ECMO, the medians of PaO(2)/ FiO(2) ratio, PIP, PEEP, and PC(dyn) became 69 mmHg, 36 cmH(2)O, 14 cmH(2)O, and 19 mL/cmH(2)O, respectively. The escalation of PIP and the declines in PaO(2)/ FiO(2) ratio and PC(dyn) were significantly correlated with the duration of MV before ECMO institution. Finally, the duration of MV (OR: 1.184, 95% CI: 1.079-1.565, p < 0.001) was found to be the only baseline ventilator parameter that independently affected the hospital mortality in these ECMO-treated patients. CONCLUSION: Since the duration of MV before ECMO institution was strongly correlated to the outcome of adult respiratory ECMO, medical centers are suggested to find a suitable prognosticating tool to determine the starting point of respiratory ECMO among their candidates with different duration of MV. TRIAL REGISTRATION: This study reported a health care intervention on human participants and was retrospectively registered. The Chang Gung Medical Foundation Institutional Review Board approved the study (no. 201601483B0 ) on November 23, 2016. All of the data were extracted from December 1, 2016, to January 31, 2017. FAU - Wu, Meng-Yu AU - Wu MY AUID- ORCID: 0000-0003-0186-4989 AD - Department of Cardiovascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. david3627@gmail.com. AD - School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan. david3627@gmail.com. FAU - Chang, Yu-Sheng AU - Chang YS AD - Department of Cardiovascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. FAU - Huang, Chung-Chi AU - Huang CC AD - Department of Thoracic Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. FAU - Wu, Tzu-I AU - Wu TI AD - Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. AD - Department of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. FAU - Lin, Pyng-Jing AU - Lin PJ AD - Department of Cardiovascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. LA - eng PT - Journal Article DEP - 20171208 PL - England TA - BMC Pulm Med JT - BMC pulmonary medicine JID - 100968563 SB - IM MH - Adult MH - Aged MH - Cohort Studies MH - *Extracorporeal Membrane Oxygenation MH - Female MH - *Hospital Mortality MH - Humans MH - Male MH - Middle Aged MH - Pneumonia, Aspiration/complications/therapy MH - Pneumonia, Bacterial/complications/therapy MH - Pneumonia, Viral/complications/therapy MH - Positive-Pressure Respiration MH - Prognosis MH - Respiration, Artificial/*methods MH - Respiratory Distress Syndrome/etiology/mortality/*therapy MH - Retrospective Studies PMC - PMC5723060 OTO - NOTNLM OT - Adult respiratory distress syndrome OT - Lung recruitment OT - Lung-protective mechanical ventilation OT - Venovenous extracorporeal membrane oxygenation COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The Chang Gung Medical Foundation Institutional Review Board (no. 201601483B0) approved the study and waived the requirement for informed consent due to the retrospective nature of this study. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: None of the authors have a conflict of interest to declare in relation to this work. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2017/12/10 06:00 MHDA- 2018/07/25 06:00 PMCR- 2017/12/08 CRDT- 2017/12/10 06:00 PHST- 2017/04/30 00:00 [received] PHST- 2017/11/23 00:00 [accepted] PHST- 2017/12/10 06:00 [entrez] PHST- 2017/12/10 06:00 [pubmed] PHST- 2018/07/25 06:00 [medline] PHST- 2017/12/08 00:00 [pmc-release] AID - 10.1186/s12890-017-0520-5 [pii] AID - 520 [pii] AID - 10.1186/s12890-017-0520-5 [doi] PST - epublish SO - BMC Pulm Med. 2017 Dec 8;17(1):181. doi: 10.1186/s12890-017-0520-5.