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Factors associated with decreased compliance after on-site extracorporeal membrane oxygenation cannulation for acute respiratory distress syndrome:A retrospective,observational cohort study

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Journal of Intensive Medicine 2024年第2期4卷 194-201页

作者： Sylvain Le Pape Florent Joly François Arrivé Jean-Pierre Frat Maeva rodriguez Maïa Joos Laura Marchasson Mathilde Wairy Arnaud WThille rémi coudroy Centre Hospitalier Universitaire de Poitiers Service de Médecine Intensive RéanimationPoitiersFrance INSErM Centre d'Investigation Clinique 1402 IS-ALIVE Research GroupUniversitéde PoitiersPoitiersFrance

Background Extracorporeal membrane oxygenation(ECMO)for acute respiratory distress syndrome(ArDS)is systematically associated with decreased respiratory system compliance(CrS).It remains unclear whether transportation to the referral ECMO center,changes in ventilatory mode or settings to achieve ultra-protective ventilation,or the natural evolution of ArDS drives this change in respiratory mechanics.Herein,we assessed the precise moment when CrS decreases after ECMO cannulation and identified factors associated with decreased CrS.Methods To rule out the effect of transportation and the different modes of ventilation on CrS,we conducted a retrospective,single-center,observational cohort study from January 2013 to May 2020,on 22 patients with severe ArDS requiring on-site ECMO and ventilated in pressure-controlled mode to achieve ultra-protective ventilation.CrS was assessed at different time points ranging from 12 h before ECMO cannulation to 72 h after ECMO cannulation.The primary outcome was the relative change in CrS between 3 h before and 3 h after ECMO cannulation.The secondary outcomes included variables associated with the relative changes in CrS within the first 3 h after ECMO cannulation and the relative changes in CrS at each time point.results CrS decreased within the first 3 h after ECMO cannulation(−28.3%,95%confidence interval[CI]:−38.8 to−17.9,Prease was mild before and after these first 3 h after ECMO cannulation.To achieve ultra-protective ventilation,respiratory rate decreased in the mean by–13 breaths/min(95%CI:−15 to−11)and driving pressure by−8.3 cmH2O(95%CI:−11.2 to−5.3),resulting in decreased tidal volume by−3.3 mL/kg of predicted body weight(95%CI:−3.9 to−2.6)as compared to before ECMO cannulation(Pr all).Plateau pressure reduction,driving pressure reduction,and tidal volume reduction were significantly associated with decreased CrS after ECMO cannulation,whereas neither respiratory rate,positive end-expiratory pressure,inspired fraction of oxygen,fluid balance

关键词： Acute respiratory distress syndrome Extacorporeal membrane oXygenation Driving pressure respiratory compliance

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High-flow nasal cannula oxygen therapy in acute hypoxemic respiratory failure and COVID-19-related respiratory failure

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Journal of Intensive Medicine 2023年第1期3卷 20-26页

作者： Jean-Pierre Frat Laura Marchasson François Arrivé rémi coudroy Centre Hospitalier Universitaire de Poitiers Médecine Intensive RéanimationPoitiers 86021France Centre d'Investigation Clinique 1402 ALIVE INSERMUniversitéde PoitiersPoitiers 86021France

Although standard oxygen face masks are first-line therapy for patients with acute hypoxemic respiratory failure,high-flow nasal cannula oxygen therapy has gained major popularity in intensive care units.The physiological effects of high-flow oxygen counterbalance the physiological consequences of acute hypoxemic respiratory failure by lessening the deleterious effects of intense and prolonged inspiratory efforts generated by patients.Its simplicity of application for physicians and nurses and its comfort for patients are other arguments for its use in this setting.Although clinical studies have reported a decreased risk of intubation with high-flow oxygen compared with standard oxygen,its survival benefit is uncertain.A more precise definition of acute hypoxemic respiratory failure,including a classification of severity based on oxygenation levels,is needed to better compare the efficiencies of different non-invasive oxygenation support methods(standard oxygen,high-flow oxygen,and non-invasive ventilation).Additionally,the respective role of each non-invasive oxygenation support method needs to be established through further clinical trials in acute hypoxemic respiratory failure,especially in severe forms.

关键词： High-flow nasal oxygen Acute respiratory failure COVID-19 Oxygen support

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Evolution of respiratory system compliance and potential for lung recruitment in COVID-19–induced acute respiratory distress syndrome

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Journal of Intensive Medicine 2022年第4期2卷 260-267页

作者： Maeva rodriguez Sylvain Le Pape François Arrivé Jean-Pierre Frat Arnaud WThille rémi coudroy CHU de Poitiers Service de Médecine Intensive RéanimationPoitiers F86000France INSErM CIC-1402 IS-ALIVE Research GroupUniversity of PoitiersPoitiers F86000France

Background:Coronavirus disease 2019(COVID-19)has been frequently complicated by severe acute respiratory distress syndrome(ArDS)with prolonged invasive ventilation.While respiratory system compliance and lung recruitability have been described within the first days after ICU admission,data about their longitudinal changes are still limited.Therefore,we conducted this study to assess the evolution of respiratory system compliance and lung recruitability in patients with COVID-19–related ArDS.Method:We conducted a prospective single-center study in patients admitted for COVID-19–related ArDS during the first wave of the pandemic,from March 16,2020 to April 10,2020.respiratory system compliance was calculated daily at clinical positive end-expiratory pressure(PEEP)during passive breathing.The potential for lung recruitment was assessed by measuring the volume derecruited between PEEP 15 cmH2 O and 5 cmH2 O,and using the calculation of the recruitment-to-inflation ratio(r/I ratio).recruitable lung was considered when the r/I ratio was at least 0.5.The primary outcome was the evolution of respiratory mechanics over time.The secondary outcome was the evolution of lung recruitability over time.results:Thirty-two patients were included in this study.The respiratory mechanics were assessed 222 times(7±5 times per patient).respiratory system compliance at clinical PEEP was 29.1 mL/cmH2 O(interquartile range[IQr]:24.1–33.9 mL/cmH2 O)and decreased significantly over time(Precruitability was assessed in 22 out of the 32 patients(60 assessments).The median volume derecruited between PEEP 15 cmH2 O and 5 cmH2 O was 246.8 mL(IQr:180.8–352.2 mL)and the median r/I ratio was 0.56(IQr:0.39–0.73).Neither changed significantly over time.The proportion of patients with recruitable lung was 50.0%(6/12)within the first 3 days after intubation,69.2%(9/13)between day 4 and day 7,and 66.7%(8/12)after day 7(P=0.7934).Conclusions:In our cohort,respiratory system compliance was low and decreased over time.The potential for lung r

关键词： Lung compliance Alveolar recruitability respiratory distress syndrome COVID-19

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