PMID- 31992674
OWN - NLM
STAT- MEDLINE
DCOM- 20201223
LR  - 20201223
IS  - 1943-3654 (Electronic)
IS  - 0020-1324 (Linking)
VI  - 65
IP  - 3
DP  - 2020 Mar
TI  - Mechanical Ventilation in Children on Venovenous ECMO.
PG  - 271-280
LID - 10.4187/respcare.07214 [doi]
AB  - BACKGROUND: Venovenous extracorporeal membrane oxygenation (VV-ECMO) is used when 
      mechanical ventilation can no longer support oxygenation or ventilation, or if 
      the risk of ventilator-induced lung injury is considered excessive. The optimum 
      mechanical ventilation strategy once on ECMO is unknown. We sought to describe 
      the practice of mechanical ventilation in children on VV-ECMO and to determine 
      whether mechanical ventilation practices are associated with clinical outcomes. 
      METHODS: We conducted a multicenter retrospective cohort study in 10 pediatric 
      academic centers in the United States. Children age 14 d through 18 y on VV-ECMO 
      from 2011 to 2016 were included. Exclusion criteria were preexisting chronic 
      respiratory failure, primary diagnosis of asthma, cyanotic heart disease, or ECMO 
      as a bridge to lung transplant. RESULTS: Conventional mechanical ventilation was 
      used in about 75% of children on VV-ECMO; the remaining subjects were managed 
      with a variety of approaches. With the exception of PEEP, there was large 
      variation in ventilator settings. Ventilator mode and pressure settings were not 
      associated with survival. Mean ventilator F(IO(2)) on days 1-3 was higher in 
      nonsurvivors than in survivors (0.5 vs 0.4, P = .009). In univariate analysis, 
      other risk factors for mortality were female gender, higher Pediatric Risk 
      Estimate Score for Children Using Extracorporeal Respiratory Support 
      (Ped-RESCUERS), diagnosis of cancer or stem cell transplant, and number of days 
      intubated prior to initiation of ECMO (all P < .05). In multivariate analysis, 
      ventilator F(IO(2)) was significantly associated with mortality (odds ratio 1.38 
      for each 0.1 increase in F(IO(2)) , 95% CI 1.09-1.75). Mortality was higher in 
      subjects on high ventilator F(IO(2)) (>/= 0.5) compared to low ventilator F(IO(2)) 
      (> 0.5) (46% vs 22%, P = .001). CONCLUSIONS: Ventilator mode and some settings 
      vary in practice. The only ventilator setting associated with mortality was 
      F(IO(2)) , even after adjustment for disease severity. Ventilator F(IO(2)) is a 
      modifiable setting that may contribute to mortality in children on VV-ECMO.
CI  - Copyright (c) 2020 by Daedalus Enterprises.
FAU - Friedman, Matthew L
AU  - Friedman ML
AD  - Division of Pediatric Critical Care, Riley Hospital for Children, Indiana 
      University, Indianapolis, Indiana. friedmml@iu.edu.
FAU - Barbaro, Ryan P
AU  - Barbaro RP
AD  - Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
AD  - Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, 
      Michigan.
FAU - Bembea, Melania M
AU  - Bembea MM
AD  - Department of Anesthesiology and Critical Care Medicine, Johns Hopkins 
      University, Baltimore, Maryland.
FAU - Bridges, Brian C
AU  - Bridges BC
AD  - Division of Pediatric Critical Care, Department of Pediatrics, Vanderbilt 
      University School of Medicine, Nashville, Tennessee.
FAU - Chima, Ranjit S
AU  - Chima RS
AD  - Department of Pediatrics, University of Cincinnati College of Medicine, 
      Cincinnati, Ohio.
AD  - Division of Critical Care Medicine, Cincinnati Children's Hospital Medical 
      Center, Cincinnati, Ohio.
FAU - Kilbaugh, Todd J
AU  - Kilbaugh TJ
AD  - Department of Anesthesiology and Critical Care Medicine, The Children's Hospital 
      of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, 
      Pennsylvania.
FAU - Pandiyan, Poornima
AU  - Pandiyan P
AD  - Department of Pediatrics, University of Kansas School of Medicine-Wichita, 
      Wichita, Kansas.
FAU - Potera, Renee M
AU  - Potera RM
AD  - Department of Pediatrics UT Southwestern Medical Center, Dallas, Texas.
FAU - Rosner, Elizabeth A
AU  - Rosner EA
AD  - Division of Pediatric Critical Care Medicine, Helen DeVos Children's Hospital, 
      Grand Rapids, Michigan.
FAU - Sandhu, Hitesh S
AU  - Sandhu HS
AD  - Division of Pediatric Critical Care, University of Tennessee Health Sciences 
      Center, Memphis, Tennessee.
FAU - Slaven, James E
AU  - Slaven JE
AD  - Department of Biostatistics, Indiana University School of Medicine, Indianapolis, 
      Indiana.
FAU - Tarquinio, Keiko M
AU  - Tarquinio KM
AD  - Division of Pediatric Critical Care Medicine, Department of Pediatrics, Emory 
      University, Children's Healthcare of Atlanta, Atlanta, Georgia.
FAU - Cheifetz, Ira M
AU  - Cheifetz IM
AD  - Division of Pediatric Critical Care, Duke Children's Hospital and Health Center, 
      Durham, North Carolina.
LA  - eng
GR  - K12 HL138039/HL/NHLBI NIH HHS/United States
PT  - Editorial
PT  - Multicenter Study
DEP - 20200128
PL  - United States
TA  - Respir Care
JT  - Respiratory care
JID - 7510357
SB  - IM
CIN - Respir Care. 2020 Mar;65(3):400-401. PMID: 32086336
MH  - Adolescent
MH  - Child
MH  - Child, Preschool
MH  - *Extracorporeal Membrane Oxygenation
MH  - Female
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Respiration, Artificial/*methods
MH  - Respiratory Distress Syndrome/therapy
MH  - Retrospective Studies
MH  - Risk Factors
MH  - United States
MH  - Ventilator-Induced Lung Injury
MH  - Ventilators, Mechanical
OTO - NOTNLM
OT  - acute respiratory distress syndrome
OT  - artificial respiration
OT  - extracorporeal membrane oxygenation
OT  - oxygen
OT  - pediatrics
OT  - ventilator-induced lung injury
EDAT- 2020/01/30 06:00
MHDA- 2020/12/29 06:00
CRDT- 2020/01/30 06:00
PHST- 2020/01/30 06:00 [pubmed]
PHST- 2020/12/29 06:00 [medline]
PHST- 2020/01/30 06:00 [entrez]
AID - respcare.07214 [pii]
AID - 10.4187/respcare.07214 [doi]
PST - ppublish
SO  - Respir Care. 2020 Mar;65(3):271-280. doi: 10.4187/respcare.07214. Epub 2020 Jan 
      28.