Spontaneous Breathing Patterns During Maximum Extracorporeal CO2 Removal in SubjectsWith Early Severe ARDS.

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  • Additional Information
    • Affiliation:
      Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
      Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
      Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, University of Ferrara, Italy
      Department of Medicine and Surgery, Research Centre on Public Health, University of Milan-Bicocca, Monza, Italy
    • Subject Terms:
    • Subject Terms:
    • Abstract:
      BACKGROUND: Switching patients affected by early severe ARDS and undergoing extracorporeal membrane oxygenation (ECMO) from controlled ventilation to spontaneous breathing can be either beneficial or harmful, depending on how effectively the breathing pattern is controlled with ECMO. Identifying the factors associated with ineffective control of spontaneous breathing with ECMO may advance our pathophysiologic understanding of this syndrome. METHODS: We conducted a prospective study in subjects with severe ARDS who were on ECMO support ≤ 7 d. Subjects were switched to minimal sedation and pressure-support ventilation while extracorporeal CO2 removal was increased to approximate the subject's total CO2 production (VCO2). We calculated the rapid shallow breathing index (RSBI) as breathing frequency divided by tidal volume. We explored the correlation between certain characteristics recorded during pretest controlled ventilation and the development of apnea (ie, expiratory pause lasting > 10 s; n = 3), normal breathing pattern (ie, apnea to RSBI ≤ 105 breaths/min/L; n = 6), and rapid shallow breathing (RSBI > 105 breaths/min/L; n = 6) that occurred during the test study. RESULTS: The ratio of extracorporeal CO2 removal to the subjects' VCO2 was >90% in all 15 subjects, and arterial blood gases remained within normal ranges. Baseline pretest Sequential Organ Failure Assessment score, total VCO2 and ventilatory ratio increased steadily, whereas PaO2/FIO2 was higher in subjects with apnea compared to intermediate RSBI >105 breaths/min/L and elevated RSBI >105 breaths/min/L. In subjects with rapid shallow breathing, baseline lung weight measured with quantitative computed tomography scored higher, as well. CONCLUSIONS: In early severe ARDS, the factors associated with rapid shallow breathing despite maximum extracorporeal CO2 extraction include less efficient CO2 and O2 exchange by the natural lung, higher severity of organ failure, and greater magnitude of lung edema.
    • Journal Subset:
      Allied Health; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA
    • ISSN:
      0020-1324
    • MEDLINE Info:
      NLM UID: 7510357
    • Notes:
      For CE see www.rcjournal.com
    • Publication Date:
      20200626
    • Publication Date:
      20200630
    • DOI:
      http://dx.doi.org/10.4187/respcare.07391
    • Accession Number:
      144207919
  • Citations
    • ABNT:
      SPINELLI, E. et al. Spontaneous Breathing Patterns During Maximum Extracorporeal CO2 Removal in SubjectsWith Early Severe ARDS. Respiratory Care, [s. l.], v. 65, n. 7, p. 911–919, 2020. DOI 10.4187/respcare.07391. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=144207919. Acesso em: 7 ago. 2020.
    • AMA:
      Spinelli E, Mauri T, Lissoni A, et al. Spontaneous Breathing Patterns During Maximum Extracorporeal CO2 Removal in SubjectsWith Early Severe ARDS. Respiratory Care. 2020;65(7):911-919. doi:10.4187/respcare.07391
    • APA:
      Spinelli, E., Mauri, T., Lissoni, A., Crotti, S., Langer, T., Albanese, M., Volta, C. A., Fornari, C., Tagliabue, P., Grasselli, G., & Pesenti, A. (2020). Spontaneous Breathing Patterns During Maximum Extracorporeal CO2 Removal in SubjectsWith Early Severe ARDS. Respiratory Care, 65(7), 911–919. https://doi.org/10.4187/respcare.07391
    • Chicago/Turabian: Author-Date:
      Spinelli, Elena, Tommaso Mauri, Alfredo Lissoni, Stefania Crotti, Thomas Langer, Marco Albanese, Carlo Alberto Volta, et al. 2020. “Spontaneous Breathing Patterns During Maximum Extracorporeal CO2 Removal in SubjectsWith Early Severe ARDS.” Respiratory Care 65 (7): 911–19. doi:10.4187/respcare.07391.
    • Harvard:
      Spinelli, E. et al. (2020) ‘Spontaneous Breathing Patterns During Maximum Extracorporeal CO2 Removal in SubjectsWith Early Severe ARDS’, Respiratory Care, 65(7), pp. 911–919. doi: 10.4187/respcare.07391.
    • Harvard: Australian:
      Spinelli, E, Mauri, T, Lissoni, A, Crotti, S, Langer, T, Albanese, M, Volta, CA, Fornari, C, Tagliabue, P, Grasselli, G & Pesenti, A 2020, ‘Spontaneous Breathing Patterns During Maximum Extracorporeal CO2 Removal in SubjectsWith Early Severe ARDS’, Respiratory Care, vol. 65, no. 7, pp. 911–919, viewed 7 August 2020, .
    • MLA:
      Spinelli, Elena, et al. “Spontaneous Breathing Patterns During Maximum Extracorporeal CO2 Removal in SubjectsWith Early Severe ARDS.” Respiratory Care, vol. 65, no. 7, July 2020, pp. 911–919. EBSCOhost, doi:10.4187/respcare.07391.
    • Chicago/Turabian: Humanities:
      Spinelli, Elena, Tommaso Mauri, Alfredo Lissoni, Stefania Crotti, Thomas Langer, Marco Albanese, Carlo Alberto Volta, et al. “Spontaneous Breathing Patterns During Maximum Extracorporeal CO2 Removal in SubjectsWith Early Severe ARDS.” Respiratory Care 65, no. 7 (July 2020): 911–19. doi:10.4187/respcare.07391.
    • Vancouver/ICMJE:
      Spinelli E, Mauri T, Lissoni A, Crotti S, Langer T, Albanese M, et al. Spontaneous Breathing Patterns During Maximum Extracorporeal CO2 Removal in SubjectsWith Early Severe ARDS. Respiratory Care [Internet]. 2020 Jul [cited 2020 Aug 7];65(7):911–9. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=144207919