| Title: |
Mechanical ventilation for acute respiratory distress syndrome during extracorporeal life support research and practice |
| Authors: |
Abrams, D; Schmidt, M; Pham, T; Beitler, JR; Fan, E; Goligher, EC; McNamee, JJ; Patroniti, N; Wilcox, ME; Combes, A; Ferguson, ND; McAuley, DF; Pesenti, A; Fraser, J |
| Publisher Information: |
American Thoracic Society |
| Publication Year: |
2020 |
| Collection: |
Griffith University: Griffith Research Online |
| Subject Terms: |
Biomedical and clinical sciences; acute respiratory distress syndrome; extracorporeal carbon dioxide removal; extracorporeal life support; extracorporeal membrane oxygenation; ventilator-induced lung injury |
| Description: |
Ventilator-induced lung injury remains a key contributor to the morbidity and mortality of acute respiratory distress syndrome (ARDS). Efforts tominimize this injury are typically limited by the need to preserve adequate gas exchange. In the most severe forms of the syndrome, extracorporeal life support is increasingly being deployed for severe hypoxemia or hypercapnic acidosis refractory to conventional ventilator management strategies. Data from a recent randomized controlled trial, a post hoc analysis of that trial, a meta-analysis, and a large international multicenter observational study suggest that extracorporeal life support, when combined with lower VT and airway pressures than the current standard of care, may improve outcomes compared with conventional management in patients with the most severe forms of ARDS. These findings raise important questions not only about the optimal ventilation strategies for patients receiving extracorporeal support but also regarding how various mechanisms of lung injury in ARDS may potentially be mitigated by ultra-lung-protective ventilation strategies when gas exchange is sufficiently managed with the extracorporeal circuit. Additional studies are needed to more precisely delineate the best strategies for optimizing invasive mechanical ventilation in this patient population. ; Full Text |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
American Journal of Respiratory and Critical Care Medicine; Abrams, D; Schmidt, M; Pham, T; Beitler, JR; Fan, E; Goligher, EC; McNamee, JJ; Patroniti, N; Wilcox, ME; Combes, A; Ferguson, ND; McAuley, DF; Pesenti, A; Fraser, J, Mechanical ventilation for acute respiratory distress syndrome during extracorporeal life support research and practice, American Journal of Respiratory and Critical Care Medicine, 2020, 201 (5), pp. 514-525; https://hdl.handle.net/10072/395347 |
| DOI: |
10.1164/rccm.201907-1283CI |
| Availability: |
https://hdl.handle.net/10072/395347; https://doi.org/10.1164/rccm.201907-1283CI |
| Rights: |
© 2020 American Thoracic Society. This is the author-manuscript version of this paper. Reproduced in accordance with the copyright policy of the publisher. Please refer to the journal website for access to the definitive, published version. ; open access |
| Accession Number: |
edsbas.3032E53F |
| Database: |
BASE |