MORTALITY IS DIRECTLY RELATED TO THE DURATION OF MECHANICAL VENTILATION BEFORE THE INITIATION OF EXTRACORPOREAL LIFE-SUPPORT FOR SEVERE RESPIRATORY-FAILURE
T. Pranikoff et al., MORTALITY IS DIRECTLY RELATED TO THE DURATION OF MECHANICAL VENTILATION BEFORE THE INITIATION OF EXTRACORPOREAL LIFE-SUPPORT FOR SEVERE RESPIRATORY-FAILURE, Critical care medicine, 25(1), 1997, pp. 28-32
Objective: To investigate the relationship between the period of mecha
nical ventilation before extracorporeal life support and survival in p
atients with respiratory failure, Design: Retrospective review, Settin
g: Surgical intensive care unit at a university medical center, Patien
ts: Thirty-six consecutive adult patients with severe respiratory fail
ure managed with extracorporeal life support, Interventions: Extracorp
oreal life support was utilized in 36 acute respiratory failure adult
patients with a variety of diagnoses and an estimated mortality rate o
f >90%, Management protocols were followed before and during extracorp
oreal life support, The 36 patients were physiologically similar befor
e extracorporeal life support was initiated: shunt of 48 +/- 17%; FIO2
of 1.0 +/- 0.1; peak inspiratory pressure of 56 +/- 16 cm H2O; positi
ve end expiratory pressure of 14 +/- 6 cm H2O; and respiratory rate of
23 +/- 10 breaths/ min, Ventilation was utilized for 1 to 17 days bef
ore extracorporeal life support, Typical lung rest settings during ext
racorporeal life support were Ro(2) of 0.40, peak inspiratory pressure
of 30 cm H2O, positive end-expiratory pressure of 10 cm H2O, and resp
iratory rate of 6 breaths/min, Death was almost always secondary to en
dstage pulmonary failure, Measurements and Main Results: Survival (hos
pital discharge) in these 36 patients was inversely associated with th
e number of days of preextracorporeal life support ventilation, with a
50% mortality rate predicted by logistic regression after 5 days of m
echanical ventilation, The overall survival rate was 18(50.0%) of 36 p
atients, Conclusion: In severe acute respiratory failure treated with
lung rest and extracorporeal life support, a predicted 50% mortality r
ate was associated with 5 days of preextracorporeal life support mecha
nical ventilation.