ECMO and Prone Position in Patients With Severe ARDS —Reply

In Reply In their Letter about our recent study, Drs Wiener and Albert suggest that incorporating periodic sigh breaths into ultraprotective lung ventilation during ECMO could potentially enhance the efficacy of prone positioning. They suggest that this approach may help expand atelectatic regions, improve lung compliance, reduce cyclical airspace opening and closing, and subsequently facilitate earlier ECMO weaning. While we acknowledge the potential appeal of this mechanical ventilation strategy, the literature currently lacks data on the utilization of periodic sigh breaths in conjunction with very low tidal volume, reduced driving pressure (ie, plateau pressure minus positive end-expiratory pressure), and respiratory rate. Physiological investigations and randomized clinical trials have primarily focused on patients with tidal volume exceeding 6 mL/kg of predicted body weight and moderately impaired lung compliance. This area warrants further exploration, particularly regarding the determination of safe plateau pressure and the duration and interval of periodic sigh breaths in patients with profoundly reduced respiratory system compliance and normalized gas exchanges (oxygenation and decarboxylation provided by ECMO).
Source: JAMA - Category: General Medicine Source Type: research