Increasing Sweep Gas Flow Reduces Respiratory Drive and Dyspnea in Nonintubated Venoarterial Extracorporeal Membrane Oxygenation Patients: A Pilot Study
Authors' conclusion
In critically ill patients with venoarterial ECMO, an increase in sweep gas flow through the oxygenation membrane decreases dyspnea, possibly mediated by a decrease in respiratory drive.
Study context
- Population
- Nonintubated, spontaneously breathing, supine patients on venoarterial extracorporeal membrane oxygenation (ECMO) for cardiogenic shock with dyspnea-VAS ≥40/100 mm
- Participants
- 21 participants
- Comparison
- Sweep gas flow increased up to +6 l/min vs baseline
- Outcome
- Dyspnea (dyspnea-VAS)
Methodological detailsphysiological interventional
- Physiological interventional
Main finding
As reported in the abstract
Dyspnea-VAS
Baseline
50
median · IQR 45–60 · mm
6 l/min
20
median · IQR 10–30
P < 0.001
- Correlation between sweep gas flow and dyspnea-VAS (r)
- −0.91; 95% CI, −0.94 to −0.87
Further findings
Dyspnea components (Multidimensional Dyspnea Profile), change
- Sensory component
- −50% [−43 to −75]
- Affective component
- −17% [−0 to −25]
- Emotional component
- −12% [−0 to −17]
- Greater decrease for sensory vs affective and emotional components
- P < 0.001
Respiratory drive (EMG activity), change
- Alae nasi
- −23% [−36 to −10]
- Parasternal
- −20 [−41 to −0]
- Significant decrease
- P < 0.001
Correlations
- Respiratory drive vs sensory component (r)
- 0.29; 95% CI, 0.13 to 0.44
- Respiratory drive vs affective component (r)
- 0.29; 95% CI, 0.02 to 0.54
- Sweep gas flow vs alae nasi EMG (r)
- −0.31; 95% CI, −0.44 to −0.22
- Sweep gas flow vs parasternal EMG (r)
- −0.25; 95% CI, −0.44 to −0.16
Original publication
Increasing Sweep Gas Flow Reduces Respiratory Drive and Dyspnea in Nonintubated Venoarterial Extracorporeal Membrane Oxygenation Patients: A Pilot Study. Anesthesiology. Published 4 March 2024. doi:10.
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