Invasive mechanical ventilation in patients with acute respiratory distress syndrome receiving extracorporeal support: a narrative review of strategies to mitigate lung injury
Issued Date
2022-01-01
Resource Type
ISSN
00032409
eISSN
13652044
Scopus ID
2-s2.0-85134539496
Pubmed ID
35864561
Journal Title
Anaesthesia
Rights Holder(s)
SCOPUS
Bibliographic Citation
Anaesthesia (2022)
Suggested Citation
Zochios V., Brodie D., Shekar K., Schultz M.J., Parhar K.K.S. Invasive mechanical ventilation in patients with acute respiratory distress syndrome receiving extracorporeal support: a narrative review of strategies to mitigate lung injury. Anaesthesia (2022). doi:10.1111/anae.15806 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/87420
Title
Invasive mechanical ventilation in patients with acute respiratory distress syndrome receiving extracorporeal support: a narrative review of strategies to mitigate lung injury
Author(s)
Author's Affiliation
College of Life Sciences
Hamilton Medical AG
The University of Queensland
New York Presbyterian Hospital
Mahidol University
Vagelos College of Physicians and Surgeons
Queensland University of Technology
Glenfield Hospital
Nuffield Department of Medicine
The Prince Charles Hospital
Universiteit van Amsterdam
University of Calgary
Hamilton Medical AG
The University of Queensland
New York Presbyterian Hospital
Mahidol University
Vagelos College of Physicians and Surgeons
Queensland University of Technology
Glenfield Hospital
Nuffield Department of Medicine
The Prince Charles Hospital
Universiteit van Amsterdam
University of Calgary
Other Contributor(s)
Abstract
Veno-venous extracorporeal membrane oxygenation is indicated in patients with acute respiratory distress syndrome and severely impaired gas exchange despite evidence-based lung protective ventilation, prone positioning and other parts of the standard algorithm for treating such patients. Extracorporeal support can facilitate ultra-lung-protective ventilation, meaning even lower volumes and pressures than standard lung-protective ventilation, by directly removing carbon dioxide in patients needing injurious ventilator settings to maintain sufficient gas exchange. Injurious ventilation results in ventilator-induced lung injury, which is one of the main determinants of mortality in acute respiratory distress syndrome. Marked reductions in the intensity of ventilation to the lowest tolerable levels under extracorporeal support may be achieved and could thereby potentially mitigate ventilator-induced lung injury and theoretically patient self-inflicted lung injury in spontaneously breathing patients with high respiratory drive. However, the benefits of this strategy may be counterbalanced by the use of continuous deep sedation and even neuromuscular blocking drugs, which may impair physical rehabilitation and impact long-term outcomes. There are currently a lack of large-scale prospective data to inform optimal invasive ventilation practices and how to best apply a holistic approach to patients receiving veno-venous extracorporeal membrane oxygenation, while minimising ventilator-induced and patient self-inflicted lung injury. We aimed to review the literature relating to invasive ventilation strategies in patients with acute respiratory distress syndrome receiving extracorporeal support and discuss personalised ventilation approaches and the potential role of adjunctive therapies in facilitating lung protection.