Association between mechanical ventilation parameters and mortality in children with respiratory failure on ECMO: a systematic review and meta-analysis
BackgroundIn refractory respiratory failure (RF), extracorporeal membrane oxygenation (ECMO) is a salvage therapy that seeks to reduce lung injury induced by mechanical ventilation. The parameters of optimal mechanical ventilation in children during ECMO are not known. Pulmonary ventilatory manageme...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-01-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2024.1302049/full |
| _version_ | 1797354466978037760 |
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| author | Jaime Fernandez-Sarmiento Maria Camila Perez Juan David Bustos Lorena Acevedo Mauricio Sarta-Mantilla Jennifer Guijarro Carlos Santacruz Daniel Felipe Pardo Daniel Castro Yinna Villa Rosero Hernando Mulett |
| author_facet | Jaime Fernandez-Sarmiento Maria Camila Perez Juan David Bustos Lorena Acevedo Mauricio Sarta-Mantilla Jennifer Guijarro Carlos Santacruz Daniel Felipe Pardo Daniel Castro Yinna Villa Rosero Hernando Mulett |
| author_sort | Jaime Fernandez-Sarmiento |
| collection | DOAJ |
| description | BackgroundIn refractory respiratory failure (RF), extracorporeal membrane oxygenation (ECMO) is a salvage therapy that seeks to reduce lung injury induced by mechanical ventilation. The parameters of optimal mechanical ventilation in children during ECMO are not known. Pulmonary ventilatory management during this therapy may impact mortality. The objective of this study was to evaluate the association between ventilatory parameters in children during ECMO therapy and in-hospital mortality.MethodsA systematic search of PubMed/MEDLINE, Embase, Cochrane, and Google Scholar from January 2013 until May 2022 (PROSPERO 450744), including studies in children with ECMO-supported RF assessing mechanical ventilation parameters, was conducted. Risk of bias was assessed using the Newcastle-Ottawa scale; heterogeneity, with absence <25% and high >75%, was assessed using I2. Sensitivity and subgroup analyses using the Mantel-Haenszel random-effects model were performed to explore the impact of methodological quality on effect size.ResultsSix studies were included. The median age was 3.4 years (IQR: 3.2–4.2). Survival in the 28-day studies was 69%. Mechanical ventilation parameters associated with higher mortality were a very low tidal volume ventilation (<4 ml/kg; OR: 4.70; 95% CI: 2.91–7.59; p < 0.01; I2: 38%), high plateau pressure (mean Dif: −0.70 95% CI: −0.18, −0.22; p < 0.01), and high driving pressure (mean Dif: −0.96 95% CI: −1.83, −0.09: p = 0.03). The inspired fraction of oxygen (p = 0.09) and end-expiratory pressure (p = 0.69) were not associated with higher mortality. Patients who survived had less multiple organ failure (p < 0.01).ConclusionThe mechanical ventilation variables associated with higher mortality in children with ECMO-supported respiratory failure are high plateau pressures, high driving pressure and very low tidal volume ventilation. No association between mortality and other parameters of the mechanical ventilator, such as the inspired fraction of oxygen or end-expiratory pressure, was found.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023450744, PROSPERO 2023 (CRD42023450744). |
| first_indexed | 2024-03-08T13:50:48Z |
| format | Article |
| id | doaj.art-f8f0969f765f4d65a4274bb6182517ff |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-03-08T13:50:48Z |
| publishDate | 2024-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-f8f0969f765f4d65a4274bb6182517ff2024-01-16T04:29:15ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602024-01-011210.3389/fped.2024.13020491302049Association between mechanical ventilation parameters and mortality in children with respiratory failure on ECMO: a systematic review and meta-analysisJaime Fernandez-Sarmiento0Maria Camila Perez1Juan David Bustos2Lorena Acevedo3Mauricio Sarta-Mantilla4Jennifer Guijarro5Carlos Santacruz6Daniel Felipe Pardo7Daniel Castro8Yinna Villa Rosero9Hernando Mulett10Department of Critical Care Medicine and Pediatrics, Universidad de La Sabana, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, ColombiaDepartment of Critical Care Medicine and Pediatrics, Universidad de La Sabana, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, ColombiaDepartment of Critical Care Medicine and Pediatrics, Universidad de La Sabana, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, ColombiaDepartment of Critical Care Medicine and Pediatrics, Universidad de La Sabana, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, ColombiaDepartment of Critical Care Medicine and Pediatrics, Universidad de La Sabana, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, ColombiaDepartment of Critical Care Medicine and Pediatrics, Universidad de La Sabana, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, ColombiaDepartment of Anesthesia and Cardiovascular Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, ColombiaDepartment of Anesthesia and Cardiovascular Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, ColombiaDepartment of Critical Care Medicine and Pediatrics, Universidad de La Sabana, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, ColombiaDepartment of Critical Care Medicine and Pediatrics, Universidad Nacional de Colombia, Bogotá, ColombiaDepartment of Critical Care Medicine and Pediatrics, Universidad de La Sabana, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, ColombiaBackgroundIn refractory respiratory failure (RF), extracorporeal membrane oxygenation (ECMO) is a salvage therapy that seeks to reduce lung injury induced by mechanical ventilation. The parameters of optimal mechanical ventilation in children during ECMO are not known. Pulmonary ventilatory management during this therapy may impact mortality. The objective of this study was to evaluate the association between ventilatory parameters in children during ECMO therapy and in-hospital mortality.MethodsA systematic search of PubMed/MEDLINE, Embase, Cochrane, and Google Scholar from January 2013 until May 2022 (PROSPERO 450744), including studies in children with ECMO-supported RF assessing mechanical ventilation parameters, was conducted. Risk of bias was assessed using the Newcastle-Ottawa scale; heterogeneity, with absence <25% and high >75%, was assessed using I2. Sensitivity and subgroup analyses using the Mantel-Haenszel random-effects model were performed to explore the impact of methodological quality on effect size.ResultsSix studies were included. The median age was 3.4 years (IQR: 3.2–4.2). Survival in the 28-day studies was 69%. Mechanical ventilation parameters associated with higher mortality were a very low tidal volume ventilation (<4 ml/kg; OR: 4.70; 95% CI: 2.91–7.59; p < 0.01; I2: 38%), high plateau pressure (mean Dif: −0.70 95% CI: −0.18, −0.22; p < 0.01), and high driving pressure (mean Dif: −0.96 95% CI: −1.83, −0.09: p = 0.03). The inspired fraction of oxygen (p = 0.09) and end-expiratory pressure (p = 0.69) were not associated with higher mortality. Patients who survived had less multiple organ failure (p < 0.01).ConclusionThe mechanical ventilation variables associated with higher mortality in children with ECMO-supported respiratory failure are high plateau pressures, high driving pressure and very low tidal volume ventilation. No association between mortality and other parameters of the mechanical ventilator, such as the inspired fraction of oxygen or end-expiratory pressure, was found.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023450744, PROSPERO 2023 (CRD42023450744).https://www.frontiersin.org/articles/10.3389/fped.2024.1302049/fullmortalityECMOchildrenrespiratory failureARDSmechanical ventilation |
| spellingShingle | Jaime Fernandez-Sarmiento Maria Camila Perez Juan David Bustos Lorena Acevedo Mauricio Sarta-Mantilla Jennifer Guijarro Carlos Santacruz Daniel Felipe Pardo Daniel Castro Yinna Villa Rosero Hernando Mulett Association between mechanical ventilation parameters and mortality in children with respiratory failure on ECMO: a systematic review and meta-analysis Frontiers in Pediatrics mortality ECMO children respiratory failure ARDS mechanical ventilation |
| title | Association between mechanical ventilation parameters and mortality in children with respiratory failure on ECMO: a systematic review and meta-analysis |
| title_full | Association between mechanical ventilation parameters and mortality in children with respiratory failure on ECMO: a systematic review and meta-analysis |
| title_fullStr | Association between mechanical ventilation parameters and mortality in children with respiratory failure on ECMO: a systematic review and meta-analysis |
| title_full_unstemmed | Association between mechanical ventilation parameters and mortality in children with respiratory failure on ECMO: a systematic review and meta-analysis |
| title_short | Association between mechanical ventilation parameters and mortality in children with respiratory failure on ECMO: a systematic review and meta-analysis |
| title_sort | association between mechanical ventilation parameters and mortality in children with respiratory failure on ecmo a systematic review and meta analysis |
| topic | mortality ECMO children respiratory failure ARDS mechanical ventilation |
| url | https://www.frontiersin.org/articles/10.3389/fped.2024.1302049/full |
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