Setting mechanical ventilation in ARDS patients during VV-ECMO: where are we?

Area of Science:

• Critical Care Medicine
• Respiratory Physiology
• Extracorporeal Life Support

Background:

• Venovenous extracorporeal membrane oxygenation (VV-ECMO) is used for severe ARDS with refractory hypoxemia.
• Mechanical ventilation (MV) support during VV-ECMO presents unique challenges regarding optimal settings.
• Minimizing ventilator-induced lung injury (VILI) is a primary concern due to reduced MV dependence.

Purpose of the Study:

• To describe various MV strategies employed during VV-ECMO in clinical practice.
• To highlight critical pathophysiological considerations for optimizing MV settings in ARDS patients on VV-ECMO.
• To address the insufficient consideration given to optimal ventilatory strategies during VV-ECMO.

Main Methods:

• Review of current clinical practices for MV settings during VV-ECMO.
• Discussion of pathophysiological principles relevant to MV in the context of VV-ECMO.
• Analysis of the balance between risks and benefits of MV when VV-ECMO support is present.

Main Results:

• Diverse MV strategies are utilized in clinical practice for patients on VV-ECMO.
• VV-ECMO significantly alters the risk-benefit profile of MV, reducing the need for aggressive ventilation.
• Specific pathophysiological factors are critical for defining optimal MV settings.

Conclusions:

• Optimal ventilatory strategies during VV-ECMO require careful consideration to prevent VILI.
• Understanding the interplay between VV-ECMO and MV is essential for patient management.
• Further research and consensus on MV settings during VV-ECMO are warranted.