PaO2/FiO(2) Deterioration During Stable Extracorporeal Membrane Oxygenation Associates With Protracted Recovery and Increased Mortality in Severe Acute Respiratory Distress Syndrome

• Type: Article in International Scientific Journal
• Date: 2016

Authors

Roncon-Albuquerque R Jr (Author) FMUP; Ferreira Coimbra, J (Author) Other; Vilares Morgado, R (Author) Other; Araújo JP (Author) FMUP; Paiva, J-A (Author) FMUP

Journal

The Journal is awaiting validation by the Administrative Services.

Title: ANNALS OF THORACIC SURGERY

Vol. 102

Pages: 1878-1885

ISSN: 0003-4975

Indexing

ISI Web of Knowledge - 4 Citations

Other information

Authenticus ID: P-00M-B67

DOI: 10.1016/j.athoracsur.2016.06.026

Abstract (EN): Background. During extracorporeal membrane oxygenation (ECMO), arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO(2); 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 preECMO management. (C) 2016 by The Society of Thoracic Surgeons

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 8