{"doi":"10.4187/respcare.07214","title":"Mechanical Ventilation in Children on Venovenous ECMO","abstract":"BACKGROUND: Venovenous extracorporeal membrane oxygenation (VV-ECMO) is used when mechanical ventilation can no longer support oxygenation or ventilation, or if the risk of ventilator-induced lung injury is considered excessive. The optimum mechanical ventilation strategy once on ECMO is unknown. We sought to describe the practice of mechanical ventilation in children on VV-ECMO and to determine whether mechanical ventilation practices are associated with clinical outcomes. METHODS: We conducted a multicenter retrospective cohort study in 10 pediatric academic centers in the United States. Children age 14 d through 18 y on VV-ECMO from 2011 to 2016 were included. Exclusion criteria were preexisting chronic respiratory failure, primary diagnosis of asthma, cyanotic heart disease, or ECMO as a bridge to lung transplant. RESULTS: Conventional mechanical ventilation was used in about 75% of children on VV-ECMO; the remaining subjects were managed with a variety of approaches. With the exception of PEEP, there was large variation in ventilator settings. Ventilator mode and pressure settings were not associated with survival. Mean ventilator F IO 2 on days 1–3 was higher in nonsurvivors than in survivors (0.5 vs 0.4, P = .009). In univariate analysis, other risk factors for mortality were female gender, higher Pediatric Risk Estimate Score for Children Using Extracorporeal Respiratory Support (Ped-RESCUERS), diagnosis of cancer or stem cell transplant, and number of days intubated prior to initiation of ECMO (all P < .05). In multivariate analysis, ventilator F IO 2 was significantly associated with mortality (odds ratio 1.38 for each 0.1 increase in F IO 2 , 95% CI 1.09-1.75). Mortality was higher in subjects on high ventilator F IO 2 (≥ 0.5) compared to low ventilator F IO 2 (> 0.5) (46% vs 22%, P = .001). CONCLUSIONS: Ventilator mode and some settings vary in practice. The only ventilator setting associated with mortality was F IO 2 , even after adjustment for disease severity. Ventilator F IO 2 is a modifiable setting that may contribute to mortality in children on VV-ECMO.","journal":"Respiratory Care","year":2020,"id":98960,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":30,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9577,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":107457,"name":"Ryan P. Barbaro","orcid":"0000-0002-3645-0359","position":1,"is_corresponding":false},{"id":250755,"name":"Melania M. Bembea","orcid":"0000-0003-4984-520X","position":2,"is_corresponding":false},{"id":487894,"name":"Brian C. Bridges","orcid":"0000-0003-2209-2121","position":3,"is_corresponding":false},{"id":287304,"name":"Ranjit S. Chima","orcid":null,"position":4,"is_corresponding":false},{"id":343803,"name":"Todd J. Kilbaugh","orcid":"0000-0002-4959-3092","position":5,"is_corresponding":false},{"id":56041,"name":"Poornima Pandiyan","orcid":null,"position":6,"is_corresponding":false},{"id":487895,"name":"Renee M. Potera","orcid":"0000-0003-3484-0318","position":7,"is_corresponding":false},{"id":489268,"name":"Elizabeth Rosner","orcid":null,"position":8,"is_corresponding":false},{"id":487896,"name":"Hitesh Sandhu","orcid":"0000-0003-0869-2841","position":9,"is_corresponding":false},{"id":376362,"name":"James E. Slaven","orcid":"0000-0002-6744-3821","position":10,"is_corresponding":false},{"id":242097,"name":"Keiko M. Tarquinio","orcid":"0000-0003-2688-1021","position":11,"is_corresponding":false},{"id":487897,"name":"Ira M. Cheifetz","orcid":"0000-0002-1174-1571","position":12,"is_corresponding":false},{"id":487893,"name":"Matthew L. Friedman","orcid":"0000-0001-8562-2914","position":0,"is_corresponding":true}],"reference_count":46,"raw_metadata":null,"created_at":"2026-07-18T22:37:35.547042Z","pmid":"31992674","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}