Effect of ultraprotective mechanical ventilation on right ventricular
function during extracorporeal membrane oxygenation in adults with acute
respiratory distress syndrome
Abstract
Background: Right ventricular dysfunction (RVD) is frequent in patients
suffering from acute respiratory distress syndrome (ARDS). Veno-venous
extracorporeal membrane oxygenation (V-V ECMO) may allow the use of
ultraprotective mechanical ventilation (MV) in the most severe cases of
ARDS. However, the effects of this MV strategy on RV function are not
well known. We investigated with echocardiography the prevalence and
evolution of RVD in patients supported with V-V ECMO for severe ARDS and
ventilated with an ultraprotective ventilation approach. Methods:
Eighteen patients who required V-V ECMO for severe ARDS and were
assessed with echocardiography before and after cannulation between
January 2014 and December 2017 were enrolled in this retrospective
observational study. Results: Before cannulation, RV dilatation was
present in 6/16 (37%) and 10/17 (59%) patients, according to
quantitative and qualitative assessment, respectively, and RVD was
reported in 9/14 (64%) patients. After cannulation, tidal volume,
plateau pressure, and driving pressure significantly decreased [median
(interquartile range) values were 2.0 (0.9-3.6) mL/kg, 20 (20–20)
cmH2O, and 10 (10–10) cmH2O, respectively] and RV size and function
were similar as before cannulation. Except for SaO2 before cannulation,
which was significantly lower in non-survivors, no other risk factor for
RVD, RV dilatation, or mortality was identified in our population.
Conclusions: In patients requiring V-V ECMO for severe ARDS, RVD and
dilatation before ECMO cannulation were frequent but not associated with
worse clinical outcomes. An ultraprotective MV strategy was not
accompanied by a worsening of RV function.