The following is the summary of “Ultra-lung-protective ventilation and biotrauma in severe ARDS patients on veno-venous extracorporeal membrane oxygenation: a randomized controlled study” published in the December 2022 issue of Critical care by Guervilly, et al.

Ventilator-induced lung injury can be reduced, and lung recovery aided by ultra-lung-protective ventilation, which may be effective during veno-venous extracorporeal membrane oxygenation (vv-ECMO) for severe acute respiratory distress syndrome (ARDS). The purpose of this study was to examine the effects of 2 ventilator techniques on vv-ECMO on pulmonary and systemic biotrauma as measured by a battery of inflammatory, epithelial, endothelial, and lung repair biomarkers. This is a randomized controlled trial with a prospective design. 

Ultra-lung-protective ventilation, consisting of very low tidal volume (1-2 mL/kg of predicted body weight), low respiratory rate (5-10 cycles per minute), positive expiratory transpulmonary pressure, and 16 hours in the prone position, or lung-protective-ventilation, which followed the ECMO arm of the EOLIA trial, were randomly assigned to patients for 48 hours (control group). Concentrations of serum advanced glycation end products and angiopoietin-2 in the blood and in the alveoli 48 hours after randomization were considered secondary outcomes. After including 39 patients, enrollment was halted due to futility. The ultra-lung-protective group had dramatically reduced tidal volume, respiratory rate, minute ventilation, plateau pressure, and mechanical power. 

After 48 hours of randomization, there was no difference in biomarker concentrations between the 2 groups. However, compared to the control group, those receiving ultra-lung protection had a greater risk of dying within 60 days (45% vs. 17%, P=0.06). Patients with vv-ECMO-supported ARDS who had ultra-lung-protective ventilation for 48 hours did not experience a reduction in biotrauma despite a large drop in mechanical power. There should be more research on how this ventilation method affects patient outcomes.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-022-04272-x