Résumé
Les indications et les facteurs de risque d’échec de la technique ainsi que le pronostic de l’utilisation d’une extracorporeal membrane oxygenation (ECMO) dans le syndrome de détresse respiratoire aiguë (SDRA) ont été particulièrement décrits depuis dix ans. Paradoxalement, la gestion de la ventilation mécanique sous ECMO a fait l’objet de peu d’études spécifiques. En conséquence, bien que de nombreuses études démontrent le bénéfice d’une ventilation protectrice dans le SDRA sans ECMO, aucun consensus n’existe sous ECMO. Les pratiques sont actuellement guidées par les habitudes de chaque centre, les opinions d’experts et les moyens locaux disponibles. Il existe néanmoins un rationnel physiopathologique, principalement fondé sur des études animales, qui justifie de promouvoir une ventilation dite « ultraprotectrice » sous ECMO. Cette stratégie devra associer une réduction du volume courant (< 6 ml/kg de poids prédit) et de la pression de plateau (< 25 cmH2O) en maintenant de hauts niveaux de pression expiratoire positive (PEP) (> 10 cmH2O). De futures études sont nécessaires pour déterminer l’impact du mode ventilatoire et de ses réglages sur le pronostic des patients sous ECMO.
Abstract
The timing and the outcome of extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) have received considerable attention, but very little has been given to mechanical ventilation during ECMO. Although the impact of a protective ventilation has been markedly demonstrated for non-ECMO-supported ventilated patients, there is no consensus with ECMO yet. Consequently, ventilation management during ECMO is based on clinician preference, experience of centers with high case volumes, and local resource availability. Nevertheless, there is a physiological rationale, mainly based on animal studies, to advise an “ultraprotective” ventilation strategy with ECMO. This strategy will combine a tidal volume reduction (< 6 ml/ kg predicted body weight) and a plateau pressure reduction (≤ 25 cmH2O) with high positive end-expiratory pressure level to provide lung recruitment (> 10 cmH2O). Future studies are urgently required to determine the best practice of mechanical ventilation during ECMO and its impact on patient-centered outcomes.
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References
Brodie D, Bacchetta M (2011) Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med 365:1905–14
Peek GJ, Mugford M, Tiruvoipati R, et al (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374:1351–63
Davies A, Jones D, Bailey M, et al (2009) Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA 302:1888–95
MacLaren G, Combes A, Bartlett RH (2012) Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era. Intensive Care Med 38:210–20
EOLIA-TRIAL. http://www.clinicaltrials.gov/ct2/show/NCT01470703?term=EOLIA+ECMO&rank=1
Brogan TV, Thiagarajan RR, Rycus PT, et al (2009) Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database. Intensive Care Med 35:2105–14
Schmidt M, Bailey M, Sheldrake J, et al (2014) Predicting survival after ECMO for severe acute respiratory failure. The Respiratory ECMO Survival Prediction (RESP)-score. Am J Respir Crit Care Med 189:1374–82
Schmidt M, Zogheib E, Roze H, et al (2013) The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Intensive Care Med 39:1704–13
Schmidt M, Tachon G, Devilliers C, et al (2013) Blood oxygenation and decarboxylation determinants during venovenous ECMO for respiratory failure in adults. Intensive Care Med 39:838–46
2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 342:1301–8
Pham T, Combes A, Roze H, et al (2013) Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. Am J Respir Crit Care Med 187:276–85
Gattinoni L, Caironi P, Pelosi P, Goodman LR (2001) What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med 164:1701–11
Vieira SR, Puybasset L, Lu Q, et al (1999) A scanographic assessment of pulmonary morphology in acute lung injury. Significance of the lower inflection point detected on the lung pressure-volume curve. Am J Respir Crit Care Med 159:1612–23
Terragni PP, Rosboch G, Tealdi A, et al (2007) Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med 175:160–6
Caironi P, Cressoni M, Chiumello D, et al (2010) Lung opening and closing during ventilation of acute respiratory distress syndrome. Am J Respir Crit Care Med 181:578–86
Mead J, Takishima T, Leith D (1970) Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol 28:596–608
Muscedere JG, Mullen JB, Gan K, Slutsky AS (1994) Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med 149:1327–34
Aboab J, Jonson B, Kouatchet A, et al (2006) Effect of inspired oxygen fraction on alveolar derecruitment in acute respiratory distress syndrome. Intensive Care Med 32:1979–86
Marhong JD, Telesnicki T, Munshi L, et al (2014) Mechanical ventilation during extracorporeal membrane oxygenation. An international survey. Ann Am Thorac Soc 11:956–61
Kredel M, Bierbaum D, Lotz C, et al (2014) Ventilation during extracorporeal membrane oxygenation for adult respiratory distress syndrome. Crit Care 18:442
Schmidt M, Stewart C, Bailey M, et al (2014) Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome: a retrospective international multicenter study. Crit Care Med (in press)
Feihl F, Eckert P, Brimioulle S, et al (2000) Permissive hypercapnia impairs pulmonary gas exchange in the acute respiratory distress syndrome. Am J Respir Crit Care Med 162:209–15
Feihl F, Perret C (1994) Permissive hypercapnia. How permissive should we be? Am J Respir Crit Care Med 150:1722–37
Frank JA, Gutierrez JA, Jones KD, et al (2002) Low tidal volume reduces epithelial and endothelial injury in acid-injured rat lungs. Am J Respir Crit Care Med 165:242–9
Hager DN, Krishnan JA, Hayden DL, Brower RG (2005) Tidal volume reduction in patients with acute lung injury when plateau pressures are not high. Am J Respir Crit Care Med 172:1241–5
Bein T, Weber-Carstens S, Goldmann A, et al (2013) Lower tidal volume strategy (approximately 3 ml/kg) combined with extracorporeal CO2 removal versus “conventional” protective ventilation (6 ml/kg) in severe ARDS: the prospective randomized Xtravent-study. Intensive Care Med 39:847–56
Somaschini M, Bellan C, Locatelli G, et al (1995) Extracorporeal membrane oxygenation with veno-venous bypass and apneic oxygenation for treatment of severe neonatal respiratory failure. Int J Artif Organs 18:574–8
Nielsen ND, Kjaergaard B, Koefoed-Nielsen J, et al (2008) Apneic oxygenation combined with extracorporeal arteriovenous carbon dioxide removal provides sufficient gas exchange in experimental lung injury. ASAIO J 54:401–5
Protti A, Votta E, Gattinoni L (2014) Which is the most important strain in the pathogenesis of ventilator-induced lung injury: dynamic or static? Curr Opin Crit Care 20:33–8
Briel M, Meade M, Mercat A, et al (2010) Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and metaanalysis. JAMA 303:865–73
Dreyfuss D, Saumon G (1998) Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med 157:294–323
ELSO Guidelines for Cardiopulmonary Extracorporeal Life Support and Patient Specific Supplements to the ELSO General Guidelines, Ann Arbor, MI www.elso.med.umich.edu April 2009
Combes A (2011) Extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS). The EOLIA (ECMO to Rescue Lung Injury in Severe ARDS) trial: a multicenter, international, randomized, controlled open trial. Réanimation 20:49–61
Réseau européen de recherche en ventilation artificielle (REVA) — Syndrome de détresse respiratoire aiguë lié à la grippe A(H1N1)— 2009 Recommandations pour l’assistance respiratoire. http://www. revaweb.org http://www.revaweb.org27 septembre 2009
Combes A, Brechot N, Luyt CE, Schmidt M (2012) What is the niche for extracorporeal membrane oxygenation in severe acute respiratory distress syndrome? Curr Opin Crit Care 18:527–32
Hormann C, Baum M, Putensen C, et al (1994) Biphasic positive airway pressure (BIPAP): a new mode of ventilatory support. Eur J Anaesthesiol 11:37–42
Yoshida T, Rinka H, Kaji A, et al (2009) The impact of spontaneous ventilation on distribution of lung aeration in patients with acute respiratory distress syndrome: airway pressure release ventilation versus pressure support ventilation. Anesth Analg 109: 1892–900
Hering R, Zinserling J, Wrigge H, et al (2005) Effects of spontaneous breathing during airway pressure release ventilation on respiratory work and muscle blood flow in experimental lung injury. Chest 128:2991–8
Putensen C, Mutz NJ, Putensen-Himmer G, Zinserling J (1999) Spontaneous breathing during ventilatory support improves ventilation-perfusion distributions in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 159:1241–8
Bein T, Osborn E, Hofmann HS, et al (2010) Successful treatment of a severely injured soldier from Afghanistan with pumpless extracorporeal lung assist and neurally adjusted ventilatory support. Int J Emerg Med 3:177–9
Mauri T, Bellani G, Grasselli G, et al (2013) Patient-ventilator interaction in ARDS patients with extremely low compliance undergoing ECMO: a novel approach based on diaphragm electrical activity. Intensive Care Med 39:282–91
Karagiannidis C, Lubnow M, Philipp A, et al (2010) Autoregulation of ventilation with neurally adjusted ventilatory assist on extracorporeal lung support. Intensive Care Med 36:2038–44
Noah MA, Peek GJ, Finney SJ, et al (2011) Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA 306:1659–68
Patroniti N, Zangrillo A, Pappalardo F, et al (2011) The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med 37:1447–57
Futier E, Paugam-Burtz C, Constantin JM, et al (2013) The OPERA trial — comparison of early nasal high flow oxygen therapy with standard care for prevention of postoperative hypoxemia after abdominal surgery: study protocol for a multicenter randomized controlled trial. Trials 14:341
Serpa-Neto A, Cardoso SO, Manetta JA, et al (2012) Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA 308:1651–9
Camporota L, Smith J, Barrett N, Beale R (2012) Assessment of regional lung mechanics with electrical impedance tomography can determine the requirement for ECMO in patients with severe ARDS. Intensive Care Med 38:2086–7
Grasso S, Terragni P, Birocco A, et al (2012) ECMO criteria for influenza A(H1N1)-associated ARDS: role of transpulmonary pressure. Intensive Care Med 38:395–403
Fuehner T, Kuehn C, Hadem J, et al (2012) Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med 185:763–8
Lang G, Taghavi S, Aigner C, et al (2012) Primary lung transplantation after bridge with extracorporeal membrane oxygenation: a plea for a shift in our paradigms for indications. Transplantation 93:729–36
Mason DP, Thuita L, Nowicki ER, et al (2010) Should lung transplantation be performed for patients on mechanical respiratory support? The US experience. J Thorac Cardiovasc Surg 139:765–73 e1
Olsson KM, Simon A, Strueber M, et al (2010) Extracorporeal membrane oxygenation in nonintubated patients as bridge to lung transplantation. Am J Transplant 10:2173–8
Hoeper MM, Wiesner O, Hadem J, et al (2013) Extracorporeal membrane oxygenation instead of invasive mechanical ventilation in patients with acute respiratory distress syndrome. Intensive Care Med 39:2056–7
Wiesner O, Hadem J, Sommer W, et al (2012) Extracorporeal membrane oxygenation in a nonintubated patient with acute respiratory distress syndrome. Eur Respir J 40:1296–8
Guervilly C, Hraiech S, Gariboldi V, et al (2014) Prone positioning during veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adults. Minerva Anestesiol 80:307–13
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Cet article correspond à la conférence faite par l’auteur au congrès de la SRLF 2015 dans la session : L’ECMO dans le SDRA: après la conférence de consensus.
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Schmidt, M., Combes, A. Comment ventiler un patient sous ECMO ou ECCO2R ?. Réanimation 24 (Suppl 2), 344–351 (2015). https://doi.org/10.1007/s13546-015-1020-8
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DOI: https://doi.org/10.1007/s13546-015-1020-8