Extracorporeal respiratory support and minimally invasive ventilation in severe ARDS.

BACKGROUND: To evaluate the results of treatment of severe acute respiratory distress syndrome (ARDS) with extracorporeal life support (ECLS), minimal sedation and low pressure supported ventilation in adults.

DESIGN AND SETTING: observational study in a tertiary referral center, Intensive Care Unit, Astrid Lindgren Children's Hospital at Karolinska Hospital, Stockholm, Sweden.

PATIENTS: thirty-eight patients aged 17-61 years (mean 38) with severe ARDS. The Murray score of pulmonary injury averaged 3.5 (3.0-4.0) and the mean PaO2/FiO2 ratio was 47 (31-65).

INTERVENTION: the patients were treated with veno-venous or veno-arterial ECLS after failure of conventional respiratory therapy. A standard ECLS circuit with no heparinized surfaces was used. The patients were minimally sedated and received pressure-supported ventilation. High inspiratory pressures were avoided.

RESULTS: 25 of the 38 patients survived (total survival rate 66%) after 2-57 days on ECLS (mean 17). Major surgical procedures were performed in several patients during bypass.

CONCLUSIONS: A high survival rate can be obtained in adult patients with severe ARDS using ECLS, minimal sedation and pressure-supported ventilation with low inspiratory pressures. Surgical complications are amenable to surgical treatment during ECLS and bleeding problems can be controlled.