Mechanical Ventilation Parameters During Extracorporeal Membrane Oxygenation for Acute Hypoxemic Respiratory Failure: A Systematic Review
Bibliographic record
Abstract
Abstract Introduction: In patients with acute hypoxemic respiratory failure (AHRF), extracorporeal membrane oxygenation (ECMO) has been utilized to support gas exchange and mitigate ventilator-induced lung injury (VILI). The optimal ventilation settings during ECMO remain unknown. The purpose of this systematic review is to describe practices surrounding mechanical ventilation and other therapies aimed at improving lung function during ECMO for AHRF. Methods: A comprehensive search strategy was developed using a combination of database-specific subject headings and text words for the main concepts of mechanical ventilation, ECMO and respiratory failure. Results were limited to humans and years 2000 to present to look at all studies published after the publication of the Acute Respiratory Distress Syndrome Network trial on May 4, 2000. We searched the following databases on May 1, 2024: Ovid MEDLINE; Ovid Embase; Cochrane Database of Systematic Reviews (Ovid); and Cochrane Central Register of Controlled Trials (Ovid). Studies included were randomized controlled trials or prospective observational studies of patients with AHRF undergoing ECMO. Results: Twenty-nine studies (3159 patients) met our inclusion criteria. Patients had a median age of 51 years (IQR 46-53). A median of 61.25% (IQR 33.10-88.28%) of patients underwent prone positioning prior to ECMO. A median of 95.4% (IQR 69.7-98.2%) of patients received neuromuscular blockade prior to ECMO. After initiation of ECMO, studies reported reductions in respiratory rate (from median 27.0 [IQR 25.0-29.2] to 16.0 [IQR 11.0-18.2] breaths per minute), tidal volume (from median 5.9 [IQR 5.7-6.0] to 3.2 [IQR 2.8-3.7] ml/kg ideal body weight), PEEP (from median 12.0 [IQR 12.0-14.0] to 12.0 [IQR 11.5-14.0] cm H2O), and driving pressure (from median 17.8 [IQR 17.0-19.0] to 12.0 [IQR 10.0-12.6] cm H2O). Conclusion: Reduction in the intensity of mechanical ventilation in patients with AHRF supported by ECMO common, suggesting that clinicians may be attempting to reduce VILI after initiation of ECMO. References:1.Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301-1308. doi:10.1056/NEJM2000050434218012.Marhong JD, Munshi L, Detsky M, Telesnicki T, Fan E. Mechanical ventilation during extracorporeal life support (ECLS): a systematic review. Intensive Care Med. 2015;41(6):994-1003. doi:10.1007/s00134-015-3716-2
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.029 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.006 |
| Bibliometrics | 0.006 | 0.008 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".