Individualized Multimodal Physiologic Approach to Mechanical Ventilation in Patients With Obesity and Severe Acute Respiratory Distress Syndrome Reduced Venovenous Extracorporeal Membrane Oxygenation Utilization

Francesco Zadek, MD; Jonah Rubin, MD; Luigi Grassi, MD; Daniel Van Den Kroonenberg, BSc; Grant Larson, BSc; Martin Capriles, BA; Roberta De Santis Santiago, MD, PhD; Gaetano Florio, MD; David A. Imber, MD; Edward A Bittner, MD, PhD; Kathryn A. Hibbert, MD; Alex Legassey, RRT; Jeliene LaRocque, RRT; Gaston Cudemus-Deseda, MD; Aranya Bagchi, MD; Jerome Crowley, MD; Kenneth Shelton, MD; Robert Kacmarek, RRT, PhD, FAARC; Lorenzo Berra, MD; for the Lung Rescue Team

doi:10.1097/CCE.0000000000000461

Critical Care Explorations (Jul 2021)

Individualized Multimodal Physiologic Approach to Mechanical Ventilation in Patients With Obesity and Severe Acute Respiratory Distress Syndrome Reduced Venovenous Extracorporeal Membrane Oxygenation Utilization

Francesco Zadek, MD,
Jonah Rubin, MD,
Luigi Grassi, MD,
Daniel Van Den Kroonenberg, BSc,
Grant Larson, BSc,
Martin Capriles, BA,
Roberta De Santis Santiago, MD, PhD,
Gaetano Florio, MD,
David A. Imber, MD,
Edward A Bittner, MD, PhD,
Kathryn A. Hibbert, MD,
Alex Legassey, RRT,
Jeliene LaRocque, RRT,
Gaston Cudemus-Deseda, MD,
Aranya Bagchi, MD,
Jerome Crowley, MD,
Kenneth Shelton, MD,
Robert Kacmarek, RRT, PhD, FAARC,
Lorenzo Berra, MD,
for the Lung Rescue Team

Affiliations

Francesco Zadek, MD: 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Jonah Rubin, MD: 2 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Luigi Grassi, MD: 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Daniel Van Den Kroonenberg, BSc: 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Grant Larson, BSc: 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Martin Capriles, BA: 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Roberta De Santis Santiago, MD, PhD: 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Gaetano Florio, MD: 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
David A. Imber, MD: 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Edward A Bittner, MD, PhD: 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Kathryn A. Hibbert, MD: 2 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Alex Legassey, RRT: 3 Department of Respiratory Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Jeliene LaRocque, RRT: 3 Department of Respiratory Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Gaston Cudemus-Deseda, MD: 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Aranya Bagchi, MD: 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Jerome Crowley, MD: 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Kenneth Shelton, MD: 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Robert Kacmarek, RRT, PhD, FAARC: 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Lorenzo Berra, MD: 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
for the Lung Rescue Team

DOI: https://doi.org/10.1097/CCE.0000000000000461
Journal volume & issue: Vol. 3, no. 7
p. e0461

Abstract

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OBJECTIVE:. To investigate whether individualized optimization of mechanical ventilation through the implementation of a lung rescue team could reduce the need for venovenous extracorporeal membrane oxygenation in patients with obesity and acute respiratory distress syndrome and decrease ICU and hospital length of stay and mortality. DESIGN:. Single-center, retrospective study at the Massachusetts General Hospital from June 2015 to June 2019. PATIENTS:. All patients with obesity and acute respiratory distress syndrome who were referred for venovenous extracorporeal membrane oxygenation evaluation due to hypoxemic respiratory failure. INTERVENTION:. Evaluation and individualized optimization of mechanical ventilation by the lung rescue team before the decision to proceed with venovenous extracorporeal membrane oxygenation. The control group was those patients managed according to hospital standard of care without lung rescue team evaluation. MEASUREMENT AND MAIN RESULTS:. All 20 patients (100%) allocated in the control group received venovenous extracorporeal membrane oxygenation, whereas 10 of 13 patients (77%) evaluated by the lung rescue team did not receive venovenous extracorporeal membrane oxygenation. Patients who underwent lung rescue team evaluation had a shorter duration of mechanical ventilation (p = 0.03) and shorter ICU length of stay (p = 0.03). There were no differences between groups in in-hospital, 30-day, or 1–year mortality. CONCLUSIONS:. In this hypothesis-generating study, individualized optimization of mechanical ventilation of patients with acute respiratory distress syndrome and obesity by a lung rescue team was associated with a decrease in the utilization of venovenous extracorporeal membrane oxygenation, duration of mechanical ventilation, and ICU length of stay. Mortality was not modified by the lung rescue team intervention.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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