Association Between Tidal Volume in Invasive Mechanical Ventilation and Mortality in Children With Extracorporeal Membrane Oxygenation.

IF 3.1 3区 医学 Q2 ENGINEERING, BIOMEDICAL ASAIO Journal Pub Date : 2024-10-24 DOI:10.1097/MAT.0000000000002341
Jennifer Guijarro, Jaime Fernández-Sarmiento, Lorena Acevedo, Mauricio Sarta-Mantilla, Hernando Mulett, Daniel Castro, Martha Cecilia Reyes Casas, Daniel Felipe Pardo, Carlos Miguel Santacruz, Ligia Tatiana Bernal, Laura Henao Ramírez, María Camila Gómez, Giovanni A Di Giovanna, Catalina Duque-Arango
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Abstract

Mechanical ventilation (MV) strategies in children on extracorporeal membrane oxygenation (ECMO) have not been studied much and the ventilatory parameters to avoid greater lung damage are still unclear. Our objective was to determine the relationship between conventional tidal volume (4-8 ml/kg, CTV) versus low tidal volume (<4 ml/kg, LTV) and mortality in children with MV at the beginning of ECMO. This was a retrospective cohort study that included 101 (10.9 months interquartile range [IQR]: 6.0-24.0) children. Children with LTV had greater odds of hospital mortality (adjusted odds ratio [aOR]: 2.45; 95% confidence interval [CI]: 1.05-5.71; p = 0.03) regardless of age, reason for ECMO, and disease severity, as well as a longer duration of MV after ECMO. We found no differences between the groups in other MV settings. The CTV group required fewer fibrobronchoscopies than patients with LTV (aOR: 0.38; 95% CI: 0.15-0.99; p = 0.04). We found that a tidal volume (VT) lower than 4 ml/kg at the onset of ECMO support in children with MV was associated with higher odds of mortality, longer post-decannulation ventilation, and a greater need for fibrobronchoscopies. Lung-protective bundles in patients with ECMO and MV should consider the VT to maintain plateau and driving pressure that avoid major lung injury caused by MV.

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体外膜肺氧合患儿有创机械通气潮气量与死亡率之间的关系
对体外膜氧合(ECMO)患儿的机械通气(MV)策略研究不多,避免肺损伤加重的通气参数仍不明确。我们的目标是确定常规潮气量(4-8 毫升/千克,CTV)与低潮气量(4-8 毫升/千克,CTV)之间的关系。
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来源期刊
ASAIO Journal
ASAIO Journal 医学-工程:生物医学
CiteScore
6.60
自引率
7.10%
发文量
651
审稿时长
4-8 weeks
期刊介绍: ASAIO Journal is in the forefront of artificial organ research and development. On the cutting edge of innovative technology, it features peer-reviewed articles of the highest quality that describe research, development, the most recent advances in the design of artificial organ devices and findings from initial testing. Bimonthly, the ASAIO Journal features state-of-the-art investigations, laboratory and clinical trials, and discussions and opinions from experts around the world. The official publication of the American Society for Artificial Internal Organs.
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