Mechanical Ventilation and ECMO:
Overview
Although not all patients on ECMO require endotracheal intubation or mechanical ventilation, the majority of ECMO patients at TGH will require mechanical ventilation at some point. Just like any ICU patient, mechanical ventilation should be done in such a way as to minimize the risk of ventilator-induced lung injury. The main difference is patients on V-A and V-V ECMO do not rely on the use of their lungs for oxygenation or ventilation. This affords the opportunity to adjust ventilation settings without worrying about hypoxia or hypercarbia.
There is not a lot of strong evidence to support one ventilation strategy over another in the context of ECLS because the studies don't exist yet. Until we know more, we apply the same principles of lung protective ventilation to ECLS patients that we do for our other patients. The main things to keep in mind are:
- Limit the FiO2 as hyperoxia can cause reabsorption atelectasis and damage lung tissue.
- Keep the plateau pressures low to protect the lungs from barotrauma.
- Use low tidal volumes to protect the lung from volutrauma.
- Maintain PEEP to avoid atelectrauma and total consolidation of the lung.
At TGH, patients are often started on "ECMO settings", which is a pressure control mode at a driving pressure of 10 cmH2O, a rate of 10 breaths per minute and a PEEP of 10 cmH2O
Next page: Mechanical ventilation and ECMO: Ventilator specifics