20190614ECMO期间的机械通气设置.pptVIP

Mechanical ventilation management during ECMO for ARDS: An International Multicenter Prospective Cohort Matthieu Schmidt1,2, Tài Pham3, Antonio Arcadipane 4, Cara Agerstrand 5, Shinichiro Ohshimo 6, Vincent Pellegrino7, Alain Vuylsteke8, Christophe Guervilly9; Shay McGuinness10, Sophie Pierard11, Jeff Breeding12; Claire Stewart13; Simon Sin Wai Ching14; Janice M Camuso15; R. Scott Stephens16; Bobby King17; Daniel Herr18 ; Marcus J Schultz19; Mathilde Neuville20; Elie Zogheib21; Jean-Paul Mira22; Hadrien Rozé23; Marc Pierrot24; Anthony Tobin25; Carol Hodgson7-26; Sylvie Chevret 27-28; Daniel Brodie*5 and Alain Combes*1,2; for the International ECMO Network (ECMONet), and the LIFEGARDS Study Group$ Am J Respir Crit Care Med. 2019 May 30. Background Although its use remains controversial ECMO may be deployed in severe forms of ARDS to decrease the intensity of MV or as a rescue therapy for refractory ARDS. The largest randomized trial of ECMO for severe forms of ARDS failed to demonstrate a statistically significant difference in its pre-specified primary endpoint of 60-day mortality (4). However, the clinically important effect size seen in the EOLIA trial as well as the recent post-hoc Bayesian analysis (5) both suggest that ECMO is efficacious in some patients with severe forms of ARDS. Background ECMO allows MV with very low TV, reduced Pplat and RR (6) thereby potentially minimizing VILI (7,8). However, ventilation strategies during ECMO have received little attention until now (9) and it is not clear how ECMO-treated ARDS patients are managed in routine practice in the broader international context, particularly with regard to MV settings and adjunctive therapies used before and after ECMO initiation. Data currently available in this area has been limited to selected retrospective cohorts (10, 11). Background The primary aim of the ventiLatIon management oF patients with Extracorporeal membrane oxyGenation for Acute Respiratory Distress Syndrome (LIFEGARDS)