Impact of ventilator settings during venovenous extracorporeal membrane oxygenation on clinical outcomes in influenza-associated acute respiratory distress syndrome: a multicenter retrospective cohort study

Ting-Yu Liao; Sheng-Yuan Ruan; Chien-Heng Lai; Li-Jung Tseng; Li-Ta Keng; You-Yi Chen; Chih-Hsien Wang; Jung-Yien Chien; Huey-Dong Wu; Yih-Sharng Chen; Chong-Jen Yu; TACTICS Study Group

doi:10.7717/peerj.14140

Impact of ventilator settings during venovenous extracorporeal membrane oxygenation on clinical outcomes in influenza-associated acute respiratory distress syndrome: a multicenter retrospective cohort study

PeerJ. 2022 Oct 10:10:e14140. doi: 10.7717/peerj.14140. eCollection 2022.

Authors

Affiliations

¹ Departments of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
² Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
³ Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Dou-Liu, Taiwan.
⁵ Thoracic Medicine Center, Department of Medicine and Surgery, National Taiwan University Hospital Yunlin Branch, Dou-Liu, Taiwan.

Abstract

Background: Patients with influenza-associated acute respiratory distress syndrome (ARDS) requiring venovenous extracorporeal membrane oxygenation (vv-ECMO) support have a high mortality rate. Ventilator settings have been known to have a substantial impact on outcomes. However, the optimal settings of mechanical ventilation during vv-ECMO are still unknown.

Methods: This multicenter retrospective cohort study was conducted in the intensive care units (ICUs) of three tertiary referral hospitals in Taiwan between July 2009 and December 2019. It aims to describe the effect of ventilator settings during vv-ECMO on patient outcomes.

Results: A total of 93 patients with influenza receiving ECMO were screened. Patients were excluded if they: were receiving venoarterial ECMO, died within three days of vv-ECMO initiation, or were transferred to the tertiary referral hospital >24 hours after vv-ECMO initiation. A total of 62 patients were included in the study, and 24 (39%) died within six months. During the first three days of ECMO, there were no differences in tidal volume (5.1 vs. 5.2 mL/kg, p = 0.833), dynamic driving pressure (15 vs. 14 cmH2O, p = 0.146), and mechanical power (11.3 vs. 11.8 J/min, p = 0.352) between survivors and non-survivors. However, respiratory rates were significantly higher in non-survivors compared with survivors (15 vs. 12 breaths/min, p = 0.013). After adjustment for important confounders, a higher mean respiratory rate of >12 breaths/min was still associated with higher mortality (adjusted hazard ratio = 3.31, 95% confidence interval = 1.10-9.97, p = 0.034).

Conclusions: In patients with influenza-associated ARDS receiving vv-ECMO support, we found that a higher respiratory rate was associated with higher mortality. Respiratory rate might be a modifiable factor to improve outcomes in this patient population.

Keywords: Acute respiratory distress syndrome; Extracorporeal membrane oxygenation; Influenza.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Extracorporeal Membrane Oxygenation* / adverse effects
Humans
Influenza, Human* / complications
Respiratory Distress Syndrome* / etiology
Retrospective Studies
Ventilators, Mechanical

Grants and funding

This work was supported by the National Taiwan University Hospital (111-S0205) and Ministry of Science and Technology, Taiwan (MOST 111-2314-B-002-201-MY3). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.