When to Remove Tracheal Intubation During ECMO Support in Lung Transplant Patients With Idiopathic Pulmonary Fibrosis

Lung transplantation is the optimal treatment choice, while extracorporeal membrane oxygenation (ECMO) provides cardiopulmonary support during the perioperative period of lung transplantation. Currently, there is no reported research on the ECMO withdrawal and duration of mechanical ventilation (MV) in idiopathic pulmonary fibrosis (IPF) patients undergoing lung transplantation. Therefore, this study aims to evaluate the impact of ECMO duration on prolonged mechanical ventilation (PMV) time in patients, attempting to explore the relationship between the two.

This study included 170 patients with IPF who underwent lung transplantation under ECMO technology. The patients were divided into normal and delayed groups based on the ECMO application time of 72 hours. A multifactor logistic regression analysis was conducted to explore the independent risk factors for PMV time, and restricted cubic spline (RCS) was used to investigate the relationship between ECMO application time and MV time. Receptor operating characteristics (ROC) were further used to find the cut-off value of ECMO application time to predict PMV time.

In the normal group, there were 135 cases, of which 79.25% (107 cases) were males and 20.74% (28 cases) were females, whereas in the delayed group, there were 35 cases, of which 57.14% (20 cases) were males and 42.86% (15 cases) were females. In the RCS curves, there was a nonlinear correlation between the duration of ECMO application and the duration of MV, which tended to increase as the duration of ECMO application increased. According to univariate and multivariate logistic analyses, ECMO application time was an influential factor in the occurrence of PMV time, in which the OR of PMV time was 2.02 (95% CI 1.11,1.63, P = .001) when ECMO application time was ≥ 52.01 hours.

After lung transplantation, there is a nonlinear relationship between the application time of ECMO and MV time in patients with IPF. The application time of ECMO can predict well the extension of MV in patients during ICU stay. Therefore, clinicians can assess the duration of MV in patients with IPF based on the application time of ECMO, further avoiding complications related to MV.