Individualized Multimodal Physiologic Approach to Mechanical Ventilation in Patients With Obesity and Severe Acute Respiratory Distress Syndrome Reduced Venovenous Extracorporeal Membrane Oxygenation Utilization
OBJECTIVE:. To investigate whether individualized optimization of mechanical ventilation through the implementation of a lung rescue team could reduce the need for venovenous extracorporeal membrane oxygenation in patients with obesity and acute respiratory distress syndrome and decrease ICU and hos...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2021-07-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000000461 |
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doaj-104d264cd7214041959af6c8089d60bd |
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Article |
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DOAJ |
| language |
English |
| format |
Article |
| sources |
DOAJ |
| author |
Francesco Zadek, MD Jonah Rubin, MD Luigi Grassi, MD Daniel Van Den Kroonenberg, BSc Grant Larson, BSc Martin Capriles, BA Roberta De Santis Santiago, MD, PhD Gaetano Florio, MD David A. Imber, MD Edward A Bittner, MD, PhD Kathryn A. Hibbert, MD Alex Legassey, RRT Jeliene LaRocque, RRT Gaston Cudemus-Deseda, MD Aranya Bagchi, MD Jerome Crowley, MD Kenneth Shelton, MD Robert Kacmarek, RRT, PhD, FAARC Lorenzo Berra, MD for the Lung Rescue Team |
| spellingShingle |
Francesco Zadek, MD Jonah Rubin, MD Luigi Grassi, MD Daniel Van Den Kroonenberg, BSc Grant Larson, BSc Martin Capriles, BA Roberta De Santis Santiago, MD, PhD Gaetano Florio, MD David A. Imber, MD Edward A Bittner, MD, PhD Kathryn A. Hibbert, MD Alex Legassey, RRT Jeliene LaRocque, RRT Gaston Cudemus-Deseda, MD Aranya Bagchi, MD Jerome Crowley, MD Kenneth Shelton, MD Robert Kacmarek, RRT, PhD, FAARC Lorenzo Berra, MD for the Lung Rescue Team Individualized Multimodal Physiologic Approach to Mechanical Ventilation in Patients With Obesity and Severe Acute Respiratory Distress Syndrome Reduced Venovenous Extracorporeal Membrane Oxygenation Utilization Critical Care Explorations |
| author_facet |
Francesco Zadek, MD Jonah Rubin, MD Luigi Grassi, MD Daniel Van Den Kroonenberg, BSc Grant Larson, BSc Martin Capriles, BA Roberta De Santis Santiago, MD, PhD Gaetano Florio, MD David A. Imber, MD Edward A Bittner, MD, PhD Kathryn A. Hibbert, MD Alex Legassey, RRT Jeliene LaRocque, RRT Gaston Cudemus-Deseda, MD Aranya Bagchi, MD Jerome Crowley, MD Kenneth Shelton, MD Robert Kacmarek, RRT, PhD, FAARC Lorenzo Berra, MD for the Lung Rescue Team |
| author_sort |
Francesco Zadek, MD |
| title |
Individualized Multimodal Physiologic Approach to Mechanical Ventilation in Patients With Obesity and Severe Acute Respiratory Distress Syndrome Reduced Venovenous Extracorporeal Membrane Oxygenation Utilization |
| title_short |
Individualized Multimodal Physiologic Approach to Mechanical Ventilation in Patients With Obesity and Severe Acute Respiratory Distress Syndrome Reduced Venovenous Extracorporeal Membrane Oxygenation Utilization |
| title_full |
Individualized Multimodal Physiologic Approach to Mechanical Ventilation in Patients With Obesity and Severe Acute Respiratory Distress Syndrome Reduced Venovenous Extracorporeal Membrane Oxygenation Utilization |
| title_fullStr |
Individualized Multimodal Physiologic Approach to Mechanical Ventilation in Patients With Obesity and Severe Acute Respiratory Distress Syndrome Reduced Venovenous Extracorporeal Membrane Oxygenation Utilization |
| title_full_unstemmed |
Individualized Multimodal Physiologic Approach to Mechanical Ventilation in Patients With Obesity and Severe Acute Respiratory Distress Syndrome Reduced Venovenous Extracorporeal Membrane Oxygenation Utilization |
| title_sort |
individualized multimodal physiologic approach to mechanical ventilation in patients with obesity and severe acute respiratory distress syndrome reduced venovenous extracorporeal membrane oxygenation utilization |
| publisher |
Wolters Kluwer |
| series |
Critical Care Explorations |
| issn |
2639-8028 |
| publishDate |
2021-07-01 |
| description |
OBJECTIVE:. To investigate whether individualized optimization of mechanical ventilation through the implementation of a lung rescue team could reduce the need for venovenous extracorporeal membrane oxygenation in patients with obesity and acute respiratory distress syndrome and decrease ICU and hospital length of stay and mortality.
DESIGN:. Single-center, retrospective study at the Massachusetts General Hospital from June 2015 to June 2019.
PATIENTS:. All patients with obesity and acute respiratory distress syndrome who were referred for venovenous extracorporeal membrane oxygenation evaluation due to hypoxemic respiratory failure.
INTERVENTION:. Evaluation and individualized optimization of mechanical ventilation by the lung rescue team before the decision to proceed with venovenous extracorporeal membrane oxygenation. The control group was those patients managed according to hospital standard of care without lung rescue team evaluation.
MEASUREMENT AND MAIN RESULTS:. All 20 patients (100%) allocated in the control group received venovenous extracorporeal membrane oxygenation, whereas 10 of 13 patients (77%) evaluated by the lung rescue team did not receive venovenous extracorporeal membrane oxygenation. Patients who underwent lung rescue team evaluation had a shorter duration of mechanical ventilation (p = 0.03) and shorter ICU length of stay (p = 0.03). There were no differences between groups in in-hospital, 30-day, or 1–year mortality.
CONCLUSIONS:. In this hypothesis-generating study, individualized optimization of mechanical ventilation of patients with acute respiratory distress syndrome and obesity by a lung rescue team was associated with a decrease in the utilization of venovenous extracorporeal membrane oxygenation, duration of mechanical ventilation, and ICU length of stay. Mortality was not modified by the lung rescue team intervention. |
| url |
http://journals.lww.com/10.1097/CCE.0000000000000461 |
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doaj-104d264cd7214041959af6c8089d60bd2021-08-25T06:43:01ZengWolters KluwerCritical Care Explorations2639-80282021-07-0137e046110.1097/CCE.0000000000000461202107000-00004Individualized Multimodal Physiologic Approach to Mechanical Ventilation in Patients With Obesity and Severe Acute Respiratory Distress Syndrome Reduced Venovenous Extracorporeal Membrane Oxygenation UtilizationFrancesco Zadek, MD0Jonah Rubin, MD1Luigi Grassi, MD2Daniel Van Den Kroonenberg, BSc3Grant Larson, BSc4Martin Capriles, BA5Roberta De Santis Santiago, MD, PhD6Gaetano Florio, MD7David A. Imber, MD8Edward A Bittner, MD, PhD9Kathryn A. Hibbert, MD10Alex Legassey, RRT11Jeliene LaRocque, RRT12Gaston Cudemus-Deseda, MD13Aranya Bagchi, MD14Jerome Crowley, MD15Kenneth Shelton, MD16Robert Kacmarek, RRT, PhD, FAARC17Lorenzo Berra, MD18for the Lung Rescue Team1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.2 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.2 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.3 Department of Respiratory Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.3 Department of Respiratory Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.OBJECTIVE:. To investigate whether individualized optimization of mechanical ventilation through the implementation of a lung rescue team could reduce the need for venovenous extracorporeal membrane oxygenation in patients with obesity and acute respiratory distress syndrome and decrease ICU and hospital length of stay and mortality. DESIGN:. Single-center, retrospective study at the Massachusetts General Hospital from June 2015 to June 2019. PATIENTS:. All patients with obesity and acute respiratory distress syndrome who were referred for venovenous extracorporeal membrane oxygenation evaluation due to hypoxemic respiratory failure. INTERVENTION:. Evaluation and individualized optimization of mechanical ventilation by the lung rescue team before the decision to proceed with venovenous extracorporeal membrane oxygenation. The control group was those patients managed according to hospital standard of care without lung rescue team evaluation. MEASUREMENT AND MAIN RESULTS:. All 20 patients (100%) allocated in the control group received venovenous extracorporeal membrane oxygenation, whereas 10 of 13 patients (77%) evaluated by the lung rescue team did not receive venovenous extracorporeal membrane oxygenation. Patients who underwent lung rescue team evaluation had a shorter duration of mechanical ventilation (p = 0.03) and shorter ICU length of stay (p = 0.03). There were no differences between groups in in-hospital, 30-day, or 1–year mortality. CONCLUSIONS:. In this hypothesis-generating study, individualized optimization of mechanical ventilation of patients with acute respiratory distress syndrome and obesity by a lung rescue team was associated with a decrease in the utilization of venovenous extracorporeal membrane oxygenation, duration of mechanical ventilation, and ICU length of stay. Mortality was not modified by the lung rescue team intervention.http://journals.lww.com/10.1097/CCE.0000000000000461 |