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• W4300910459 abstract "ECMO facilitates exchange of oxygen and carbon dioxide, unburdening the ventilator of these tasks. There is no consensus as to how the ventilator should be set during ECMO, but the principles involve ameliorating ventilator-induced injury and maintaining recruitment. Generally, this involves lower tidal volumes, lower airway pressures, and much lower respiratory rates than when ECMO is not employed. Experience with ultra-low tidal volumes (2–4 mL per kg) is accumulating. PEEP can be adjusted according to measures of recruitment. Prone positioning appears feasible and safe in experienced hands. It has the potential to optimize recruitment without raising airway pressures, potentially further reducing the risks of ventilator-induced lung injury. An early transition from controlled to assisted ventilation may reduce ventilator-induced diaphragm dysfunction, enhance gas exchange, reduce sedative needs, and speed liberation from ECMO. On the other hand, excessive patient effort, despite ECMO, may provoke asynchrony, amplify lung injury, and worsen outcomes. Assessing respiratory drive and effort (airway occlusion pressure, esophageal pressure) to fine-tune the interaction between ECMO and ventilator is critical to exploit benefits and limit risks. Finally, we discuss awake ECMO, in which patients are semi-electively cannulated for ECMO without intubation (applicable generally for patients with chronic disease undergoing transplantation) or are extubated while still requiring ECMO. Potentially, an extubation-first approach could avoid some of the harms related to tracheal intubation, sedation, and bed rest.KeywordsMechanical ventilationPEEPLung-protective ventilationVentilator-induced lung injuryRecruitmentUltra-protective ventilationAwake ECMOVentilator-induced diaphragm dysfunctionProne ventilationAsynchronyMonitoring" @default.
• W4300910459 created "2022-10-04" @default.
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• W4300910459 date "2022-01-01" @default.
• W4300910459 modified "2023-09-23" @default.
• W4300910459 title "Ventilator Management During ECLS" @default.
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• W4300910459 doi "https://doi.org/10.1007/978-3-031-05299-6_6" @default.
• W4300910459 hasPublicationYear "2022" @default.
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