Luigi Camporota1,2, Elena V Caricola1,2,3, Nicola Bartolomeo4, Rossella Di Mussi3, Duncan L A Wyncoll1,2, Christopher I S Meadows1,2, Laura Amado-Rodriguez1,2,5,6,7,8, Francesco Vasques1,2, Barnaby Sanderson1,2, Guy W Glover1,2, Nicholas A Barrett1,2, Manu Shankar-Hari1,2,9, Salvatore Grasso3. 1. Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK. 2. Division of Centre of Human Applied Physiological Sciences, King's College London, London, UK. 3. Department of Emergency and Organ Transplants (DETO), Anesthesiology and Intensive Care, Università degli Studi di Bari "Aldo Moro", Bari, Italy. 4. Department of Biomedical Sciences and Human Oncology, Chair of Medical Statistics, Università degli Studi Aldo Moro, Bari, Italy. 5. Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain. 6. Centro de investigación biomédica en Red-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain. 7. Cardiac Critical Care Unit, University Central Hospital of Asturias, Oviedo, Spain. 8. Department of Functional Biology, University of Oviedo, Oviedo, Spain. 9. Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College, London, UK.
Abstract
OBJECTIVES: Quantification of potential for lung recruitment may guide the ventilatory strategy in acute respiratory distress syndrome. However, there are no quantitative data on recruitability in patients with severe acute respiratory distress syndrome who require extracorporeal membrane oxygenation. We sought to quantify potential for lung recruitment and its relationship with outcomes in this cohort of patients. DESIGN: A single-center, retrospective, observational cohort study. SETTING: Tertiary referral severe respiratory failure center in a university hospital in the United Kingdom. PATIENTS: Forty-seven adults with severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: In patients with severe acute respiratory distress syndrome-mainly of pulmonary origin (86%)-the potential for lung recruitment and the weight of nonaerated, poorly aerated, normally aerated, and hyperaerated lung tissue were assessed at low (5 cmH2O) and high (45 cmH2O) airway pressures. Patients were categorized as high or low potential for lung recruitment based on the median potential for lung recruitment value of the study population. The median potential for lung recruitment was 24.3% (interquartile range = 11.4-37%) ranging from -2% to 76.3% of the total lung weight. Patients with potential for lung recruitment above the median had significantly shorter extracorporeal membrane oxygenation duration (8 vs 13 d; p = 0.013) and shorter ICU stay (15 vs 22 d; p = 0.028), but mortality was not statistically different (24% vs 46%; p = 0.159). CONCLUSIONS: We observed significant variability in potential for lung recruitment in patients with severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. Patients with high potential for lung recruitment had a shorter ICU stay and shorter extracorporeal membrane oxygenation duration.
OBJECTIVES: Quantification of potential for lung recruitment may guide the ventilatory strategy in acute respiratory distress syndrome. However, there are no quantitative data on recruitability in patients with severe acute respiratory distress syndrome who require extracorporeal membrane oxygenation. We sought to quantify potential for lung recruitment and its relationship with outcomes in this cohort of patients. DESIGN: A single-center, retrospective, observational cohort study. SETTING: Tertiary referral severe respiratory failure center in a university hospital in the United Kingdom. PATIENTS: Forty-seven adults with severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: In patients with severe acute respiratory distress syndrome-mainly of pulmonary origin (86%)-the potential for lung recruitment and the weight of nonaerated, poorly aerated, normally aerated, and hyperaerated lung tissue were assessed at low (5 cmH2O) and high (45 cmH2O) airway pressures. Patients were categorized as high or low potential for lung recruitment based on the median potential for lung recruitment value of the study population. The median potential for lung recruitment was 24.3% (interquartile range = 11.4-37%) ranging from -2% to 76.3% of the total lung weight. Patients with potential for lung recruitment above the median had significantly shorter extracorporeal membrane oxygenation duration (8 vs 13 d; p = 0.013) and shorter ICU stay (15 vs 22 d; p = 0.028), but mortality was not statistically different (24% vs 46%; p = 0.159). CONCLUSIONS: We observed significant variability in potential for lung recruitment in patients with severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. Patients with high potential for lung recruitment had a shorter ICU stay and shorter extracorporeal membrane oxygenation duration.
Authors: Joe Zhang; Blair Merrick; Genex L Correa; Luigi Camporota; Andrew Retter; Andrew Doyle; Guy W Glover; Peter B Sherren; Stephen J Tricklebank; Sangita Agarwal; Boris E Lams; Nicholas A Barrett; Nicholas Ioannou; Jonathan Edgeworth; Christopher I S Meadows Journal: ERJ Open Res Date: 2020-10-26
Authors: Mirko Belliato; Francesco Epis; Luca Cremascoli; Fiorenza Ferrari; Maria Giovanna Quattrone; Christoph Fisser; Maximilian Valentin Malfertheiner; Fabio Silvio Taccone; Matteo Di Nardo; Lars Mikael Broman; Roberto Lorusso Journal: Membranes (Basel) Date: 2021-01-02
Authors: Dominik J Vogel; Ambra Fabbri; Andrea Falvo; Jonah Powell-Tuck; Nishita Desai; Francesco Vasques; Chris Meadows; Nicholas Ioannou; Guy Glover; Aimée Brame; Peter Sherren; Andrew Retter; Ronak Rajani; Luigi Camporota Journal: Crit Care Explor Date: 2021-02-22
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