RT Journal Article
SR Electronic
T1 Spontaneous Breathing Patterns During Maximum Extracorporeal CO<sub>2</sub> Removal in Subjects With Early Severe ARDS
JF Respiratory Care
FD American Association for Respiratory Care
SP 911
OP 919
DO 10.4187/respcare.07391
VO 65
IS 7
A1 Elena Spinelli
A1 Tommaso Mauri
A1 Alfredo Lissoni
A1 Stefania Crotti
A1 Thomas Langer
A1 Marco Albanese
A1 Carlo Alberto Volta
A1 Carla Fornari
A1 Paola Tagliabue
A1 Giacomo Grasselli
A1 Antonio Pesenti
YR 2020
UL http://rc.rcjournal.com/content/65/7/911.abstract
AB BACKGROUND: Switching patients affected by early severe ARDS and undergoing extracorporeal membrane oxygenation (ECMO) from controlled ventilation to spontaneous breathing can be either beneficial or harmful, depending on how effectively the breathing pattern is controlled with ECMO. Identifying the factors associated with ineffective control of spontaneous breathing with ECMO may advance our pathophysiologic understanding of this syndrome.METHODS: We conducted a prospective study in subjects with severe ARDS who were on ECMO support ≤ 7 d. Subjects were switched to minimal sedation and pressure-support ventilation while extracorporeal CO2 removal was increased to approximate the subject’s total CO2 production (). We calculated the rapid shallow breathing index (RSBI) as breathing frequency divided by tidal volume. We explored the correlation between certain characteristics recorded during pretest controlled ventilation and the development of apnea (ie, expiratory pause lasting &gt; 10 s; n = 3), normal breathing pattern (ie, apnea to RSBI ≤ 105 breaths/min/L; n = 6), and rapid shallow breathing (RSBI &gt; 105 breaths/min/L; n = 6) that occurred during the test study.RESULTS: The ratio of extracorporeal CO2 removal to the subjects’ was &gt;90% in all 15 subjects, and arterial blood gases remained within normal ranges. Baseline pretest Sequential Organ Failure Assessment score, total and ventilatory ratio increased steadily, whereas / was higher in subjects with apnea compared to intermediate RSBI ≤105 breaths/min/L and elevated RSBI &gt;105 breaths/min/L. In subjects with rapid shallow breathing, baseline lung weight measured with quantitative computed tomography scored higher, as well.CONCLUSIONS: In early severe ARDS, the factors associated with rapid shallow breathing despite maximum extracorporeal CO2 extraction include less efficient CO2 and O2 exchange by the natural lung, higher severity of organ failure, and greater magnitude of lung edema.