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Article

On the Transition from Control Modes to Spontaneous Modes during ECMO

1
Department of Emergency Medicine, University of New Mexico, Albuquerque, NM 87131, USA
2
Division of Emergency Medicine, Department of Surgery, University of Utah Health, Salt Lake City, UT 84132, USA
3
Division of Critical Care, Department of Anesthesiology, University of Utah Health, Salt Lake City, UT 84132, USA
4
Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT 84132, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Lakshmi Raman
J. Clin. Med. 2021, 10(5), 1001; https://doi.org/10.3390/jcm10051001
Received: 28 January 2021 / Revised: 17 February 2021 / Accepted: 18 February 2021 / Published: 2 March 2021
The transition from control modes to spontaneous modes is ubiquitous for mechanically ventilated patients yet there is little data describing the changes and patterns that occur to breathing during this transition for patients on ECMO. We identified high fidelity data among a diverse cohort of 419 mechanically ventilated patients on ECMO. We examined every ventilator change, describing the differences in >30,000 sets of original ventilator observations, focused around the time of transition from control modes to spontaneous modes. We performed multivariate regression with mixed effects, clustered by patient, to examine changes in ventilator characteristics within patients, including a subset among patients with low compliance (<30 milliliters (mL)/centimeters water (cmH2O)). We found that during the transition to spontaneous modes among patients with low compliance, patients exhibited greater tidal volumes (471 mL (364,585) vs. 425 mL (320,527); p < 0.0001), higher respiratory rate (23 breaths per minute (bpm) (18,28) vs. 18 bpm (14,23); p = 0.003), greater mechanical power (elastic component) (0.08 mL/(cmH2O × minute) (0.05,0.12) vs. 0.05 mL/(cmH2O × minute) (0.02,0.09); p < 0.0001) (range 0 to 1.4), and lower positive end expiratory pressure (PEEP) (6 cmH2O (5,8) vs. 10 cmH2O (8,11); p < 0.0001). For patients on control modes, the combination of increased tidal volume and increased respiratory rate was temporally associated with significantly low partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio (p < 0.0001). These changes in ventilator parameters warrant prospective study, as they may be associated with worsened lung injury. View Full-Text
Keywords: mechanical ventilation; spontaneous breathing; ARDS; respiratory failure; ECMO mechanical ventilation; spontaneous breathing; ARDS; respiratory failure; ECMO
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MDPI and ACS Style

Stephens, K.; Mitchell, N.; Overton, S.; Tonna, J.E. On the Transition from Control Modes to Spontaneous Modes during ECMO. J. Clin. Med. 2021, 10, 1001. https://doi.org/10.3390/jcm10051001

AMA Style

Stephens K, Mitchell N, Overton S, Tonna JE. On the Transition from Control Modes to Spontaneous Modes during ECMO. Journal of Clinical Medicine. 2021; 10(5):1001. https://doi.org/10.3390/jcm10051001

Chicago/Turabian Style

Stephens, Krista, Nathan Mitchell, Sean Overton, and Joseph E. Tonna 2021. "On the Transition from Control Modes to Spontaneous Modes during ECMO" Journal of Clinical Medicine 10, no. 5: 1001. https://doi.org/10.3390/jcm10051001

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