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Research ArticleOriginal Research

Association Between Mortality and Ventilator Parameters in Children With Respiratory Failure on ECMO

Tadashi R Miya, Jamie M Furlong-Dillard, Johnna M Sizemore, Kathleen L Meert, Heidi J Dalton, Ron W Reeder and David K Bailly
Respiratory Care February 2023, respcare.10107; DOI: https://doi.org/10.4187/respcare.10107
Tadashi R Miya
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
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  • For correspondence: [email protected]
Jamie M Furlong-Dillard
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Louisville, Norton Children’s Hospital, Louisville, Kentucky.
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Johnna M Sizemore
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Louisville, Norton Children’s Hospital, Louisville, Kentucky.
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Kathleen L Meert
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, Michigan.
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Heidi J Dalton
Department of Pediatrics, INOVA Fairfax Medical Center, Falls Church, Virginia.
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Ron W Reeder
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
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David K Bailly
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
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Abstract

BACKGROUND: In refractory respiratory failure, extracorporeal membrane oxygenation (ECMO) is a rescue therapy to prevent ventilator-induced lung injury. Optimal ventilator parameters during ECMO remain unknown. Our objective was to describe the association between mortality and ventilator parameters during ECMO for neonatal and pediatric respiratory failure.

METHODS: We performed a secondary analysis of the Bleeding and Thrombosis on ECMO dataset. Ventilator parameters included breathing frequency, tidal volume, peak inspiratory pressure, PEEP, dynamic driving pressure, pressure support, mean airway pressure, and FIO2. Parameters were evaluated before cannulation, on the calendar day of ECMO initiation (ECMO day 1), and the day before ECMO separation.

RESULTS: Of 237 included subjects analyzed, 64% were neonates, of whom 36% had a congenital diaphragmatic hernia. Of all the subjects, 67% were supported on venoarterial ECMO. Overall in-hospital mortality was 35% (n = 83). The median (interquartile range) PEEP on ECMO day 1 was 8 (5.0–10.0) cm H2O for neonates and 10 (8.0–10.0) cm H2O for pediatric subjects. By multivariable analysis, higher PEEP on ECMO day 1 in neonates was associated with lower odds of in-hospital mortality (odds ratio 0.77, 95% CI 0.62–0.92; P = .01), with a further amplified effect in neonates with congenital diaphragmatic hernia (odds ratio 0.59, 95% CI 0.41–0.86; P = .005). No ventilator type or parameter was associated with mortality in pediatric subjects.

CONCLUSIONS: Avoiding low PEEP on ECMO day 1 for neonates on ECMO may be beneficial, particularly those with a congenital diaphragmatic hernia. No additional ventilator parameters were associated with mortality in either neonatal or pediatric subjects. PEEP is a modifiable parameter that may improve neonatal survival during ECMO and requires further investigation.

  • extracorporeal membrane oxygenation
  • neonate
  • pediatric
  • respiratory failure
  • mortality
  • ventilatory-induced lung injury
  • mechanical ventilation
  • PEEP
  • hernias
  • diaphragmatic
  • congenital

Footnotes

  • Correspondence: Tadashi R Miya MD, Division of Pediatric Critical Care Medicine, Department of Pediatrics, 295 Chipeta Way, Salt Lake City, UT 84108. E-mail: tadashi.miya{at}hsc.utah.edu
  • Copyright © 2023 by Daedalus Enterprises

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Respiratory Care: 68 (4)
Respiratory Care
Vol. 68, Issue 4
1 Apr 2023
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Association Between Mortality and Ventilator Parameters in Children With Respiratory Failure on ECMO
Tadashi R Miya, Jamie M Furlong-Dillard, Johnna M Sizemore, Kathleen L Meert, Heidi J Dalton, Ron W Reeder, David K Bailly
Respiratory Care Feb 2023, respcare.10107; DOI: 10.4187/respcare.10107

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Association Between Mortality and Ventilator Parameters in Children With Respiratory Failure on ECMO
Tadashi R Miya, Jamie M Furlong-Dillard, Johnna M Sizemore, Kathleen L Meert, Heidi J Dalton, Ron W Reeder, David K Bailly
Respiratory Care Feb 2023, respcare.10107; DOI: 10.4187/respcare.10107
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Keywords

  • extracorporeal membrane oxygenation
  • neonate
  • Pediatric
  • respiratory failure
  • mortality
  • ventilatory-induced lung injury
  • mechanical ventilation
  • PEEP
  • hernias
  • diaphragmatic
  • congenital

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