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PaO2/FiO2 Deterioration During Stable Extracorporeal Membrane Oxygenation Associates With Protracted Recovery and Increased Mortality in Severe Acute Respiratory Distress Syndrome.
Ann Thorac Surg. 2016 Dec; 102(6):1878-1885.AT

Abstract

BACKGROUND

During extracorporeal membrane oxygenation (ECMO), arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2; PF ratio reflects native and artificial lung blood oxygenation). In this study we analyzed PF ratio during ECMO support and its association with clinical outcome.

METHODS

This was a single-center observational study of adult patients (n = 81) undergoing veno-venous ECMO support for severe acute respiratory distress syndrome.

RESULTS

In 37 patients (46%) PF ratio decreased from ECMO-day 1 to ECMO-day 7 (PF ratio deterioration [PF-d]; -37 ± 6.1 mm Hg), whereas in 44 patients PF ratio improved (PF-i; 65 ± 10.8 mm Hg). PF-d group required prolonged ECMO (median 21 days [interquartile range (IQR)]:14-35 days] versus 13 days [IQR: 10-20 days]) and invasive mechanical ventilation (median 33 days [IQR: 24-52 days] versus 26 days [IQR: 22-34 days]), longer intensive care unit (median 44 days [IQR: 32-74 days] versus 30 days [IQR: 25-47 days]), and hospital (median 66 days [IQR: 39-95 days] versus 36 days [IQR: 28-54 days]) lengths of stay, with higher hospital mortality rates (48.7% versus 22.7%). ECMO oxygenation did not explain PF ratio variation that remained stable in PF-d and decreased in PF-i (198 ± 12.7 mL/min versus 171 ± 8.8 mL/min). Pre-ECMO PF ratio, neuromuscular blockade, and prone position, as well as ventilatory variables did not differ between groups. The PF-d group was older (49 ± 2.1 years versus 41 ± 1.8 years) and presented lower Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) scores (0.57 ± 0.63 versus 2.2 ± 0.52). With the use of logistic regression, PF ratio variation remained an independent predictor of hospital mortality after adjusting for age or RESP score.

CONCLUSIONS

In severe acute respiratory distress syndrome, PF ratio deterioration during stable ECMO associates with protracted recovery and increased mortality, not accounted for by patient baseline characteristics, acute respiratory distress syndrome severity, or pre-ECMO management.

Authors+Show Affiliations

Department of Emergency and Intensive Care Medicine, Centro Hospitalar S. João, Porto, Portugal; Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: rra_jr@yahoo.com.Department of Internal Medicine, Centro Hospitalar S. João, Porto, Portugal.Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.Department of Infectious Diseases, Centro Hospitalar S. João, Porto, Portugal.Department of Emergency and Intensive Care Medicine, Centro Hospitalar S. João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

27592605

Citation

Roncon-Albuquerque, Roberto, et al. "PaO2/FiO2 Deterioration During Stable Extracorporeal Membrane Oxygenation Associates With Protracted Recovery and Increased Mortality in Severe Acute Respiratory Distress Syndrome." The Annals of Thoracic Surgery, vol. 102, no. 6, 2016, pp. 1878-1885.
Roncon-Albuquerque R, Ferreira-Coimbra J, Vilares-Morgado R, et al. PaO2/FiO2 Deterioration During Stable Extracorporeal Membrane Oxygenation Associates With Protracted Recovery and Increased Mortality in Severe Acute Respiratory Distress Syndrome. Ann Thorac Surg. 2016;102(6):1878-1885.
Roncon-Albuquerque, R., Ferreira-Coimbra, J., Vilares-Morgado, R., Figueiredo, P., & Paiva, J. A. (2016). PaO2/FiO2 Deterioration During Stable Extracorporeal Membrane Oxygenation Associates With Protracted Recovery and Increased Mortality in Severe Acute Respiratory Distress Syndrome. The Annals of Thoracic Surgery, 102(6), 1878-1885. https://doi.org/10.1016/j.athoracsur.2016.06.026
Roncon-Albuquerque R, et al. PaO2/FiO2 Deterioration During Stable Extracorporeal Membrane Oxygenation Associates With Protracted Recovery and Increased Mortality in Severe Acute Respiratory Distress Syndrome. Ann Thorac Surg. 2016;102(6):1878-1885. PubMed PMID: 27592605.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - PaO2/FiO2 Deterioration During Stable Extracorporeal Membrane Oxygenation Associates With Protracted Recovery and Increased Mortality in Severe Acute Respiratory Distress Syndrome. AU - Roncon-Albuquerque,Roberto,Jr AU - Ferreira-Coimbra,João, AU - Vilares-Morgado,Rodrigo, AU - Figueiredo,Paulo, AU - Paiva,José Artur, Y1 - 2016/09/01/ PY - 2016/02/19/received PY - 2016/05/05/revised PY - 2016/06/08/accepted PY - 2016/9/7/pubmed PY - 2017/4/11/medline PY - 2016/9/6/entrez SP - 1878 EP - 1885 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 102 IS - 6 N2 - BACKGROUND: During extracorporeal membrane oxygenation (ECMO), arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2; PF ratio reflects native and artificial lung blood oxygenation). In this study we analyzed PF ratio during ECMO support and its association with clinical outcome. METHODS: This was a single-center observational study of adult patients (n = 81) undergoing veno-venous ECMO support for severe acute respiratory distress syndrome. RESULTS: In 37 patients (46%) PF ratio decreased from ECMO-day 1 to ECMO-day 7 (PF ratio deterioration [PF-d]; -37 ± 6.1 mm Hg), whereas in 44 patients PF ratio improved (PF-i; 65 ± 10.8 mm Hg). PF-d group required prolonged ECMO (median 21 days [interquartile range (IQR)]:14-35 days] versus 13 days [IQR: 10-20 days]) and invasive mechanical ventilation (median 33 days [IQR: 24-52 days] versus 26 days [IQR: 22-34 days]), longer intensive care unit (median 44 days [IQR: 32-74 days] versus 30 days [IQR: 25-47 days]), and hospital (median 66 days [IQR: 39-95 days] versus 36 days [IQR: 28-54 days]) lengths of stay, with higher hospital mortality rates (48.7% versus 22.7%). ECMO oxygenation did not explain PF ratio variation that remained stable in PF-d and decreased in PF-i (198 ± 12.7 mL/min versus 171 ± 8.8 mL/min). Pre-ECMO PF ratio, neuromuscular blockade, and prone position, as well as ventilatory variables did not differ between groups. The PF-d group was older (49 ± 2.1 years versus 41 ± 1.8 years) and presented lower Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) scores (0.57 ± 0.63 versus 2.2 ± 0.52). With the use of logistic regression, PF ratio variation remained an independent predictor of hospital mortality after adjusting for age or RESP score. CONCLUSIONS: In severe acute respiratory distress syndrome, PF ratio deterioration during stable ECMO associates with protracted recovery and increased mortality, not accounted for by patient baseline characteristics, acute respiratory distress syndrome severity, or pre-ECMO management. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/27592605/PaO2/FiO2_Deterioration_During_Stable_Extracorporeal_Membrane_Oxygenation_Associates_With_Protracted_Recovery_and_Increased_Mortality_in_Severe_Acute_Respiratory_Distress_Syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(16)30733-0 DB - PRIME DP - Unbound Medicine ER -