Low-Frequency Ventilation May Facilitate Weaning in Acute Respiratory Distress Syndrome Treated with Extracorporeal Membrane Oxygenation: A Randomized Controlled Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Inclusion Criteria and Randomization
2.3. Interventions
- Data sources
- Endpoints/Aims
- Statistical methods
3. Results
- Main findings
- Outcome data
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Control Group | Treatment Group | |
---|---|---|
Duration | 72 h from inclusion 1 | |
Ventilation Mode | Conventional settings 2 | Pressure controlled ventilation |
Respiratory Rate | 12–25 per minute | 4–5 per minute |
PEEP | ≥10 cm H2O | 14–16 cm H2O 3 |
Peak Pressure | <30 cm H2O | 23–25 cm H2O 4 |
Tidal Volume | <6 mL/kg PBW | 4 mL/kg PBW |
I:E | 1:1–1:2 | 1:5 |
All Patients | Control | Treatment | p Value | ||
---|---|---|---|---|---|
Age, mean (SD)–years | 56(±12) | 56(±10) | 56(±14) | 0.912 | |
Sex, Male, no. (%) | 31(70) | 16(73) | 15(68) | 1 | |
BMI, mean (SD)–kg/m2 | 30(±9) | 30(±11) | 29(±6) | 0.738 | |
COVID-19, no. (%) | 26(59) | 12(55) | 14(64) | 0.759 | |
SAPS III, mean (SD) | 64(±14) | 60(±14) | 67(±13) | 0.074 | |
Tracheostomy, no. (%) | 30(68) | 18(82) | 12(55) | 0.106 | |
COMORBIDITIES | All patients | Control | Treatment | p value | |
Arterial hypertension, no. (%) | 19(43) | 9(41) | 10(45) | 0.851 | |
Chronic heart disease, no. (%) | 6(14) | 2(9) | 4(18) | 0.659 | |
Obesity, no. (%) | 5(11) | 3(14) | 2(9) | 0.690 | |
Diabetes, no. (%) | 8(18) | 3(14) | 5(23) | 0.794 | |
Chronic respiratory disease, no. (%) | 8(18) | 3(14) | 5(23) | 0.672 | |
Chronic kidney disease, no. (%) | 18(41) | 10(23) | 8(18) | 0.759 | |
Immunosuppression, no. (%) | 6(14) | 4(18) | 2(9) | 0.763 | |
VENTILATION PRE-ECMO | All patients | Control | Treatment | p value | |
PEEP, mean (SD)–cm H2O | 12(±3) | 11(±3) | 12(±3) | 0.316 | |
TV, mean (SD)–ml | 355(±141) | 401(±144) | 309(±126) | 0.030 | |
TV, mean (SD)–ml/kg PBW | 5.4(±2.1) | 6.2(±2.2) | 4.6(±1.9) | 0.013 | |
Respiratory rate, mean (SD)–/min | 18(±5) | 20(±4) | 16(±6) | 0.021 | |
Peak pressure, mean (SD)–cm H2O | 29(±4) | 31(±3) | 27(±4) | 0.003 | |
Driving pressure, mean (SD)–cm H2O | 17(±5) | 19(±3) | 15(±5) | 0.001 | |
MP, median (IQR)–J/min | 18.6(9.6,28.9), n = 43 | 26.9(18.6,33.2), n = 21 | 10.7(8.5,19.9), n = 22 | 0.002 | |
BASELINE VALUES PRE-ECMO | All patients | Control | Treatment | p value | |
pre-ECMO IMV, median (IQR)–days | 6(1,10) | 2.5(1,8) | 7.5 (5.2,10) | 0.015 | |
PaO2/FiO2, mean (SD) | 96(±62) | 82(±50) | 109(±71) | 0.324 | |
PaO2, mean (SD)–mmHg | 73(±20), n = 40 | 73(± 19), n = 19 | 72(±21), n = 21 | 0.875 | |
PaCO2, mean (SD)–mmHg | 71(±27), n = 40 | 68(±19), n = 19 | 73(±33), n = 21 | 0.521 | |
pH, mean (SD)–mmHg | 7.29(±0.13), n = 40 | 7.31(±0.10), n = 19 | 7.27(±0.15), n = 21 | 0.403 | |
BE, mean (SD)–mmol/L | 6(±6), n = 40 | 6(±6), n = 19 | 5(±7), n = 21 | 0.553 | |
NMBA, no. (%) | 20(45%) | 11(50%) | 9(41%) | 0.762 |
ECMO CONFIGURATION MEAN DURING 72 h on ECMO | All Patients | Control | Treatment | p Value |
---|---|---|---|---|
Venoarterial, no. (%) | 6(14%) | 1(5%) | 5(23%) | 0.188 |
Venovenous, no. (%) | 38(86%) | 21(95%) | 17(77%) | 0.188 |
ECMO blood flow, mean (SD)-l/min | 3.2(±0.7) | 3.1(±0.6) | 3.3(±0.8) | 0.373 |
ECMO sweep gas flow, mean (SD)-l/min | 3.9(±1.2) | 3.6(±1.3) | 4.3(±1.1) | 0.066 |
OUTCOME | All Patients | Control | Treatment | p Value |
---|---|---|---|---|
Ventilator-free days until day 28, mean (SD)–days | 4.2(±5.8) | 3(±5.5) | 5.4(±6) | 0.117 |
ICU LOS, median (IQR)–days | 30(17,45) | 34(18,46) | 27(15,43) | 0.526 |
ECMO duration, median (IQR)–days | 13(7,27) | 16(8,30) | 12(6,23) | 0.372 |
ICU mortality, no. (%) | 21(48) | 13(59) | 8(36) | 0.227 |
28-day mortality, no. (%) | 12(27) | 5(23) | 7(32) | 0.735 |
90-day mortality, no. (%) | 17(39) | 10(45) | 7(32) | 0.536 |
pre-ECMO IMV, mean (SD)–days vs. ICU death | 8(±8) | 8(±6) | 8(±10) | 0.997 |
CAUSE OF DEATH | All patients | Control | Treatment | p value |
Multiorgan failure, no. (%) | 7(16) | 4(18) | 3(14) | 1 |
Intracranial bleeding, no. (%) | 2(5) | 2(9) | 0(0) | 0.57 |
Heart failure, no. (%) | 2(5) | 1(5) | 1(5) | 0.864 |
COVID-19 ARDS, no. (%) | 3(7) | 1(5) | 2(9) | 0.784 |
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Hermann, M.; König, S.; Laxar, D.; Krall, C.; Kraft, F.; Krenn, K.; Baumgartner, C.; Tretter, V.; Maleczek, M.; Hermann, A.; et al. Low-Frequency Ventilation May Facilitate Weaning in Acute Respiratory Distress Syndrome Treated with Extracorporeal Membrane Oxygenation: A Randomized Controlled Trial. J. Clin. Med. 2024, 13, 5094. https://doi.org/10.3390/jcm13175094
Hermann M, König S, Laxar D, Krall C, Kraft F, Krenn K, Baumgartner C, Tretter V, Maleczek M, Hermann A, et al. Low-Frequency Ventilation May Facilitate Weaning in Acute Respiratory Distress Syndrome Treated with Extracorporeal Membrane Oxygenation: A Randomized Controlled Trial. Journal of Clinical Medicine. 2024; 13(17):5094. https://doi.org/10.3390/jcm13175094
Chicago/Turabian StyleHermann, Martina, Sebastian König, Daniel Laxar, Christoph Krall, Felix Kraft, Katharina Krenn, Clemens Baumgartner, Verena Tretter, Mathias Maleczek, Alexander Hermann, and et al. 2024. "Low-Frequency Ventilation May Facilitate Weaning in Acute Respiratory Distress Syndrome Treated with Extracorporeal Membrane Oxygenation: A Randomized Controlled Trial" Journal of Clinical Medicine 13, no. 17: 5094. https://doi.org/10.3390/jcm13175094