Abstract:
BACKGROUND:Switching patients affected by early severe ARDS and undergoing extracorporeal membrane oxygenation (ECMO) from controlled ventilation to spontaneous breathing can be either beneficial or harmful, depending on how effectively the breathing pattern is controlled with ECMO. Identifying the factors associated with ineffective control of spontaneous breathing with ECMO may advance our pathophysiologic understanding of this syndrome. METHODS:We conducted a prospective study in subjects with severe ARDS who were on ECMO support ≤ 7 d. Subjects were switched to minimal sedation and pressure-support ventilation while extracorporeal CO2 removal was increased to approximate the subject's total CO2 production ([Formula: see text]). We calculated the rapid shallow breathing index (RSBI) as breathing frequency divided by tidal volume. We explored the correlation between certain characteristics recorded during pretest controlled ventilation and the development of apnea (ie, expiratory pause lasting > 10 s; n= 3), normal breathing pattern (ie, apnea to RSBI ≤ 105 breaths/min/L; n= 6), and rapid shallow breathing (RSBI > 105 breaths/min/L; n= 6) that occurred during the test study. RESULTS:The ratio of extracorporeal CO2 removal to the subjects' [Formula: see text] was >90% in all 15 subjects, and arterial blood gases remained within normal ranges. Baseline pretest Sequential Organ Failure Assessment score, total [Formula: see text] and ventilatory ratio increased steadily, whereas [Formula: see text]/[Formula: see text] was higher in subjects with apnea compared to intermediate RSBI ≤105 breaths/min/L and elevated RSBI >105 breaths/min/L. In subjects with rapid shallow breathing, baseline lung weight measured with quantitative computed tomography scored higher, as well. CONCLUSIONS:In early severe ARDS, the factors associated with rapid shallow breathing despite maximum extracorporeal CO2 extraction include less efficient CO2 and O2 exchange by the natural lung, higher severity of organ failure, and greater magnitude of lung edema.
journal_name
Respir Carejournal_title
Respiratory careauthors
Spinelli E,Mauri T,Lissoni A,Crotti S,Langer T,Albanese M,Volta CA,Fornari C,Tagliabue P,Grasselli G,Pesenti Adoi
10.4187/respcare.07391subject
Has Abstractpub_date
2020-07-01 00:00:00pages
911-919issue
7eissn
0020-1324issn
1943-3654pii
respcare.07391journal_volume
65pub_type
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