title: Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis : Mechanical ventilation during ECMO.
abstract: OBJECTIVE
  Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for patients with acute respiratory distress syndrome (ARDS). The aim of this study was to evaluate associations between ventilatory settings during ECMO for refractory hypoxemia and outcome in ARDS patients.
  
  
  METHODS
  In this individual patient data meta-analysis of observational studies in adult ARDS patients receiving ECMO for refractory hypoxemia, a time-dependent frailty model was used to determine which ventilator settings in the first 3 days of ECMO had an independent association with in-hospital mortality.
  
  
  RESULTS
  Nine studies including 545 patients were included. Initiation of ECMO was accompanied by significant decreases in tidal volume size, positive end-expiratory pressure (PEEP), plateau pressure, and driving pressure (plateau pressure - PEEP) levels, and respiratory rate and minute ventilation, and resulted in higher PaO2/FiO2, higher arterial pH and lower PaCO2levels. Higher age, male gender and lower body mass index were independently associated with mortality. Driving pressure was the only ventilatory parameter during ECMO that showed an independent association with in-hospital mortality [adjusted HR, 1.06 (95 % CI, 1.03-1.10)].
  
  
  CONCLUSIONS
  In this series of ARDS patients receiving ECMO for refractory hypoxemia, driving pressure during ECMO was the only ventilator setting that showed an independent association with in-hospital mortality.
authors: Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. aryserpa@terra.com.br.|Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil. aryserpa@terra.com.br.|Faculdade de Medicina do ABC, Program of Post-Graduation, Research and Innovation, Santo André, Brazil. aryserpa@terra.com.br.
authors: Ary
authors: http://orcid.org/0000-0003-1520-9387
authors: A
authors: Serpa Neto
authors: Department of Epidemiology and Preventive Medicine; Australian and New Zealand Intensive Care Research Centre, School of Public Health, Monash University, Melbourne, Australia.|Medical-Surgical Intensive Care Unit, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institute of Cardiometabolism and Nutrition (iCAN), Paris, France.
authors: Matthieu
authors: M
authors: Schmidt
authors: Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.|Intensive Care Unit, Emergency Medicine Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors: Luciano C P
authors: LC
authors: Azevedo
authors: Department of Anesthesia and Operative Intensive Care, Regensburg University Hospital, Regensburg, Germany.
authors: Thomas
authors: T
authors: Bein
authors: Li Ka Shing Institute and Keenan Research Centre, St Michael's Hospital, Toronto, Canada.|Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.|INSERM U9555, Université Paris-Est, Créteil, France.
authors: Laurent
authors: L
authors: Brochard
authors: Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
authors: Gernot
authors: G
authors: Beutel
authors: Medical-Surgical Intensive Care Unit, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institute of Cardiometabolism and Nutrition (iCAN), Paris, France.|Service de Réanimation Médicale, Université Pierre et Marie Curie-Paris VI, Paris, France.
authors: Alain
authors: A
authors: Combes
authors: Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.|Intensive Care Unit, Emergency Medicine Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors: Eduardo L V
authors: EL
authors: Costa
authors: Department of Epidemiology and Preventive Medicine; Australian and New Zealand Intensive Care Research Centre, School of Public Health, Monash University, Melbourne, Australia.|Intensive Care Department, Alfred Hospital, Melbourne, VIC, Australia.
authors: Carol
authors: C
authors: Hodgson
authors: Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus N, Denmark.
authors: Christian
authors: C
authors: Lindskov
authors: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
authors: Matthias
authors: M
authors: Lubnow
authors: Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
authors: Catherina
authors: C
authors: Lueck
authors: Legacy Emanuel Medical Center, Portland, OR, USA.
authors: Andrew J
authors: AJ
authors: Michaels
authors: Department of Emergency and Intensive Care, Faculty of Medicine, Centro Hospitalar Sao João, University of Porto, Porto, Portugal.
authors: Jose-Artur
authors: JA
authors: Paiva
authors: Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.|Intensive Care Unit, Emergency Medicine Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors: Marcelo
authors: M
authors: Park
authors: Department of Health Science, University of Milan-Bicocca, Monza, Italy.|Department of Emergency Medicine, San Gerardo Hospital, Monza, Italy.
authors: Antonio
authors: A
authors: Pesenti
authors: Service de Réanimation Médicale, Groupe Hospitalier Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.|UMR 1153, Inserm, Sorbonne Paris Cité, ECSTRA Team, Université Paris Diderot, Paris, France.|UMR 915, Inserm, Université Paris Est Créteil, Créteil, France.
authors: Tài
authors: T
authors: Pham
authors: Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medicine, Georg-August-University Göttingen, Göttingen, Germany.
authors: Michael
authors: M
authors: Quintel
authors: Department of Anaesthesia and Intensive Care Medicine, University of Rome "La Sapienza", Rome, Italy.
authors: V
authors: V
authors: Marco Ranieri
authors: Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors: Michael
authors: M
authors: Ried
authors: Department of Emergency and Intensive Care, Faculty of Medicine, Centro Hospitalar Sao João, University of Porto, Porto, Portugal.
authors: Roberto
authors: R
authors: Roncon-Albuquerque
authors: Interdepartmental Division of Critical Care Medicine, University of Toronto; Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
authors: Arthur S
authors: AS
authors: Slutsky
authors: Department of Intensive Care Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan.
authors: Shinhiro
authors: S
authors: Takeda
authors: Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Azienda Ospedaliero-Universitaria Sassari, University of Sassari, Sassari, Italy.
authors: Pier Paolo
authors: PP
authors: Terragni
authors: Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus N, Denmark.
authors: Marie
authors: M
authors: Vejen
authors: Department of Anesthesia and Operative Intensive Care Medicine, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany.
authors: Steffen
authors: S
authors: Weber-Carstens
authors: Department of Pulmonary Medicine, German Centre for Lung Research, Hannover Medical School, Hannover, Germany.
authors: Tobias
authors: T
authors: Welte
authors: Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors: Marcelo
authors: M
authors: Gama de Abreu
authors: Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, University of Genoa, Genoa, Italy.
authors: Paolo
authors: P
authors: Pelosi
authors: Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.|Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Marcus J
authors: MJ
authors: Schultz
mesh_terms: D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D000860:Hypoxia / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D011175:Positive-Pressure Respiration; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012737:Sex Factors; D013990:Tidal Volume; D013997:Time Factors; D012122:Ventilators, Mechanical / Q000592:standards
keywords: ARDS; Driving pressure; ECMO; Mechanical ventilation; PEEP; Refractory hypoxemia