Abstract:
OBJECTIVE:To describe mechanical ventilation settings in adult patients treated for an acute respiratory distress syndrome with extracorporeal membrane oxygenation and assess the potential impact of mechanical ventilation settings on ICU mortality. DESIGN:Retrospective observational study. SETTING:Three international high-volume extracorporeal membrane oxygenation centers. PATIENTS:A total of 168 patients treated with extracorporeal membrane oxygenation for severe acute respiratory distress syndrome from January 2007 to January 2013. INTERVENTIONS:We analyzed the association between mechanical ventilation settings (i.e. plateau pressure, tidal volume, and positive end-expiratory pressure) on ICU mortality using multivariable logistic regression model and Cox-proportional hazards model. MEASUREMENT AND MAIN RESULTS:We obtained detailed demographic, clinical, daily mechanical ventilation settings and ICU outcome data. One hundred sixty-eight patients (41 ± 14 years old; PaO2/FIO2 67 ± 19 mm Hg) fulfilled our inclusion criteria. Median duration of extracorporeal membrane oxygenation and ICU stay were 10 days (6-18 d) and 28 days (16-42 d), respectively. Lower positive end-expiratory pressure levels and significantly lower plateau pressures during extracorporeal membrane oxygenation were used in the French center than in both Australian centers (23.9 ± 1.4 vs 27.6 ± 3.7 and 27.8 ± 3.6; p < 0.0001). Overall ICU mortality was 29%. Lower positive end-expiratory pressure levels (until day 7) and lower delivered tidal volume after 3 days on extracorporeal membrane oxygenation were associated with significantly higher mortality (p < 0.05). In multivariate analysis, higher positive end-expiratory pressure levels during the first 3 days of extracorporeal membrane oxygenation support were associated with lower mortality (odds ratio, 0.75; 95% CI, 0.64-0.88; p = 0.0006). Other independent predictors of ICU mortality included time between ICU admission and extracorporeal membrane oxygenation initiation, plateau pressure greater than 30 cm H2O before extracorporeal membrane oxygenation initiation, and lactate level on day 3 of extracorporeal membrane oxygenation support. CONCLUSIONS:Protective mechanical ventilation strategies were routinely used in high-volume extracorporeal membrane oxygenation centers. However, higher positive end-expiratory pressure levels during the first 3 days on extracorporeal membrane oxygenation support were independently associated with improved survival. Further prospective trials on the optimal mechanical ventilation strategy during extracorporeal membrane oxygenation support are warranted.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Schmidt M,Stewart C,Bailey M,Nieszkowska A,Kelly J,Murphy L,Pilcher D,Cooper DJ,Scheinkestel C,Pellegrino V,Forrest P,Combes A,Hodgson Cdoi
10.1097/CCM.0000000000000753subject
Has Abstractpub_date
2015-03-01 00:00:00pages
654-64issue
3eissn
0090-3493issn
1530-0293journal_volume
43pub_type
杂志文章,多中心研究abstract:OBJECTIVES:Mild decrease in core temperature (therapeutic hypothermia) provides lasting neuroprotection following cardiac arrest or cerebral ischemia. However, current methods for producing therapeutic hypothermia trigger a cold-defense response that must be countered by sedatives, muscle paralytics, and mechanical ven...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000229
更新日期:2014-05-01 00:00:00
abstract::Critical care clinicians no longer consider family members as visitors in the intensive care unit. Family-centered care has emerged from the results of qualitative and quantitative studies evaluating the specific needs of families of patients dying in the intensive care unit. In addition, interventional studies have e...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000237049.44246.8C
更新日期:2006-11-01 00:00:00
abstract::Seven dogs with electromagnetic flow probes implanted on their main (QT) and left (QL) pulmonary arteries, had catheters placed in their left atria and pulmonary artery, and were ventilated via Carlen's double-lumen endotracheal tubes. The effect of high-frequency oscillation (HFO) on the redistribution of pulmonary b...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198405000-00008
更新日期:1984-05-01 00:00:00
abstract::Intravenous dobutamine was used in ten patients requiring aggressive therapy for massive pulmonary embolism with circulatory failure. Except in one patient who rapidly died, a 30-min dobutamine infusion (8.3 +/- 2.7 micrograms/kg . min) increased both cardiac index (from 1.7 +/- 0.4 to 2.3 +/- 0.6 L/min . m2, p less t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198512000-00004
更新日期:1985-12-01 00:00:00
abstract:OBJECTIVES:To compare in the same patient with septic shock, respective effects of epinephrine, norepinephrine, and the combination of norepinephrine and dobutamine (5 microg/kg/min) on systemic hemodynamic parameters and gastric mucosal perfusion using gastric tonometry and laser-Doppler flowmetry techniques. DESIGN:...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199905000-00021
更新日期:1999-05-01 00:00:00
abstract::These guidelines were developed to provide a reference for preparing policies on admission and discharge for pediatric intensive care units (PICUs). They represent a consensus opinion of physicians, nurses, and allied health care professionals. By using this document as a framework for developing multidisciplinary adm...
journal_title:Critical care medicine
pub_type: 指南,杂志文章,实务指引
doi:
更新日期:1999-04-01 00:00:00
abstract:OBJECTIVES:Clinical providers have access to a number of pharmacologic agents during in-hospital cardiac arrest. Few studies have explored medication administration patterns during in-hospital cardiac arrest. Herein, we examine trends in use of pharmacologic interventions during in-hospital cardiac arrest both over tim...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003506
更新日期:2019-02-01 00:00:00
abstract:OBJECTIVE:Because anemia of inflammation is common in ICU patients and hepcidin is the key regulator of iron homeostasis, we examined time-dependent changes in hepcidin, erythropoietin, iron, and inflammatory markers in surgical ICU patients with anemia. DESIGN:Prospective single-center clinical noninterventional stud...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003089
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVE:To develop a scheme for early identification of individuals at risk for symptomatic vasospasm after subarachnoid hemorrhage (SAH). DESIGN:Analysis of prospectively collected data from the placebo-treated group in a multicenter clinical trial. SETTINGS:Fifty-four neurosurgical centers in North America. MEAS...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00003246-200004000-00012
更新日期:2000-04-01 00:00:00
abstract:OBJECTIVE:To investigate glycemic dynamics and its relation with mortality in critically ill patients. We searched for differences in complexity of the glycemic profile between survivors and nonsurvivors in patients admitted to a multidisciplinary intensive care unit. DESIGN:Prospective, observational study, convenien...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181ce49cf
更新日期:2010-03-01 00:00:00
abstract:OBJECTIVES:To outline both the preclinical and clinical data demonstrating surfactant alterations in acute lung injury, which provide the rationale for testing exogenous surfactant administration in this setting. We also review the results of the randomized, controlled clinical trials conducted to date that have evalua...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000057911.19145.9F
更新日期:2003-04-01 00:00:00
abstract:OBJECTIVE:To assess the impact of sepsis classification and multidrug-resistance status on outcome in patients receiving appropriate initial antibiotic therapy. DESIGN:A retrospective cohort study. SETTING:Barnes-Jewish Hospital, a 1,250-bed teaching hospital. PATIENTS:Individuals with Enterobacteriaceae sepsis, sev...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001013
更新日期:2015-08-01 00:00:00
abstract::The authors have examined cardiopulmonary resuscitation (CPR) skills retention in a police force initially trained to instructor level performance skills as defined by the 1977 American Heart Association Instructor Manual. In 1977, the entire Winnipeg Police Force received a basic 8-h course of CPR training with recor...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198011000-00011
更新日期:1980-11-01 00:00:00
abstract:OBJECTIVES:Cardiovascular dysfunction occurs in the majority of asphyxiated neonates and has been suggested to be a major cause of neonatal morbidity and mortality. We previously demonstrated that cyclosporine A treatment during resuscitation can significantly improve cardiovascular performance in asphyxiated newborn p...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182746704
更新日期:2013-04-01 00:00:00
abstract:OBJECTIVE:As the Surviving Sepsis Campaign was assessing patient-level data over multiple countries, we sought to evaluate the use of a pragmatic and parsimonious severity-of-illness scoring system for patients with sepsis in an attempt to provide appropriate comparisons with practical application. DESIGN:Prospective,...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000416
更新日期:2014-09-01 00:00:00
abstract:OBJECTIVE:Comparison of two versions of bispectral index (BIS) derived from the electroencephalogram in mechanically ventilated and continuously sedated patients after major abdominal surgery. DESIGN:Prospective, cohort, observational, unblinded study. SETTING:Surgical intensive care unit of a university hospital. P...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/01.ccm.0000156291.04287.7f
更新日期:2005-03-01 00:00:00
abstract:OBJECTIVE:End-of-life practices vary worldwide. The objective was to demonstrate that there is no clear-cut distinction between treatments administered to relieve pain and suffering and those intended to shorten the dying process. DESIGN:Secondary analysis of a prospective, observational study. SETTING:Thirty-seven i...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.CCM.0000295304.99946.58
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVE:To compare four different methods of endotracheal lidocaine administration with respect to the site of administration. DESIGN:Randomized controlled trial. SETTING:University hospital. PATIENTS:Thirty-two female patients (43.6 +/- 11.5 years old) undergoing elective gynecologic operations with an anesthesio...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199107000-00015
更新日期:1991-07-01 00:00:00
abstract:OBJECTIVES:To compare the effects of two lung-protective ventilation strategies on pulmonary vascular mechanics in early acute respiratory distress syndrome. DESIGN:Experimental study. SETTING:University animal research laboratory. SUBJECTS:Twelve pigs (30.8 ± 2.5 kg). INTERVENTIONS:Acute respiratory distress syndr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002701
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVES:Recently, the definition of sepsis has changed from a physiologic derangement (Sepsis-1 and -2) to organ dysfunction (Sepsis-3) based. We sought to determine the concordance between the different sepsis phenotypes and how that affected mortality. DESIGN:Retrospective, multicenter study. SETTING:Three acade...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004449
更新日期:2020-09-01 00:00:00
abstract:OBJECTIVE:Leucine-rich repeat and immunoglobulin domain-containing protein (LINGO)-1 is expressed in neural stem cells, and its neutralization results in sustained neuronal immaturity. Thus, targeted inhibition of LINGO-1 via RNA interference may enhance transplanted neural stem cell survival and neuronal differentiati...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001351
更新日期:2016-03-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to test the hypothesis that cocaine-induced cerebral vasodilation in newborn sheep is mediated via beta-adrenergic receptor activation. DESIGN:The cerebral effects of a single intravenous injection of cocaine (4 mg/kg) given 30 mins after pretreatment with propranolol (1 mg/kg...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199904000-00036
更新日期:1999-04-01 00:00:00
abstract:OBJECTIVE:The goals of this review article are to review the importance and value of standardized definitions in clinical research, as well as to propose the necessary tools and infrastructure needed to advance nosology and medial taxonomy to improve the quality of clinical trials in the field of critical care. DATA S...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181920ee8
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVES:To determine the rate of unplanned PICU readmissions, examine the characteristics of index admissions associated with readmission, and compare outcomes of readmissions versus index admissions. DESIGN:Retrospective cohort analysis. SETTING:Ninety North American PICUs that participated in the Virtual Pediatr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31829eb970
更新日期:2013-12-01 00:00:00
abstract:OBJECTIVE:Intracranial pressure (ICP) monitoring is frequently used in intensive care treatment of patients with intracranial hemorrhage. Data demonstrating an improved outcome from this intervention are lacking. We analyzed standardized mortality ratios in patients with and without ICP monitoring to determine its effi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000065270.53951.9E
更新日期:2003-05-01 00:00:00
abstract:OBJECTIVE:Although it is established that septic shock induces immunosuppression, the mechanisms for this phenomenon remain poorly understood. Human leukocyte antigen-G exerts strong inhibitory effects that are directed at different arms of the immune system. The main objective of the current study was to measure human...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000277039.84372.1C
更新日期:2007-08-01 00:00:00
abstract:OBJECTIVES:To examine the effect of extracorporeal membrane oxygenation (ECMO) therapy on platelet function and number and to determine the in vivo survival of transfused platelets during ECMO. DESIGN:Prospective study of all neonates treated with ECMO during a 6-month period. SETTING:Neonatal intensive care unit in ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199307000-00018
更新日期:1993-07-01 00:00:00
abstract:BACKGROUND:The early detection of bacterial meningitis is crucial for successful outcome. Heparin-binding protein, a potent inducer of increased vascular permeability, is released from activated neutrophils in severe sepsis. OBJECTIVE:In this study we investigated whether heparin-binding protein levels in cerebrospina...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318206c396
更新日期:2011-04-01 00:00:00
abstract:OBJECTIVES:Cardiac surgery-associated acute kidney injury occurs in up to 50% of patients and is associated with increased mortality and morbidity. This study aimed to discover if perioperative urinary alkalinization with sodium bicarbonate infusion reduces the prevalence of cardiac surgery-associated acute kidney inju...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/CCM.0b013e31828a3f99
更新日期:2013-07-01 00:00:00
abstract::Arterial oxygen saturation, determined noninvasively by pulse oximetry in 32 pediatric patients with cyanotic congenital heart disease (CHD), was compared with oxygen saturation measured by a cooximeter in simultaneously obtained arterial blood samples. The patients were studied in the cardiac catheterization laborato...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198711000-00015
更新日期:1987-11-01 00:00:00