title: Mechanical ventilation in patients subjected to extracorporeal membrane oxygenation (ECMO).
abstract: Mechanical ventilation (MV) is a crucial element in the management of acute respiratory distress syndrome (ARDS), because there is high level evidence that a low tidal volume of 6ml/kg (protective ventilation) improves survival. In these patients with refractory respiratory insufficiency, venovenous extracorporeal membrane oxygenation (ECMO) can be used. This salvage technique improves oxygenation, promotes CO2clearance, and facilitates protective and ultraprotective MV, potentially minimizing ventilation-induced lung injury. Although numerous trials have investigated different ventilation strategies in patients with ARDS, consensus is lacking on the optimal MV settings during venovenous ECMO. Although the concept of "lung rest" was introduced years ago, there are no evidence-based guidelines on its use in application to MV in patients supported by ECMO. How MV in ECMO patients can promote lung recovery and weaning from ventilation is not clear. The purpose of this review is to describe the ventilation strategies used during venovenous ECMO in clinical practice.
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España. Electronic address: martalopez@humv.es.
authors.forename: M
authors.initials: M
authors.lastname: López Sanchez
mesh_terms: D002245:Carbon Dioxide / Q000097:blood; D003199:Computer Systems; D017097:Electric Impedance; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology; D011175:Positive-Pressure Respiration; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000009:adverse effects; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D056152:Respiratory Rate; D013990:Tidal Volume; D055397:Ventilator-Induced Lung Injury / Q000209:etiology / Q000517:prevention & control
chemical_list: D002245:Carbon Dioxide
keywords: Acute respiratory distress syndrome; Driving pressure; Extracorporeal CO2 removal; Extracorporeal membrane oxygenation; Lesión pulmonar asociada a ventilación mecánica; Lung rest; Mechanical ventilation; Membrana de oxigenación extracorpórea; Membrana de oxigenación extracorpórea venovenosa; Protective ventilation; Sistemas depuradores de carbónico; Síndrome de distrés respiratorio agudo; Ultraprotective ventilation; Venovenous extracorporeal membrane oxygenation; Ventilación mecánica; Ventilación protectora; Ventilación ultraprotectora; Ventilator induced lung injury