The following is a summary of the article titled “Dual titration of minute ventilation and sweep gas flow to control carbon dioxide variations in patients on venovenous extracorporeal membrane oxygenation,” published in the May 2023 issue of Critical Care by Masi et al.

Venovenous extracorporeal membrane oxygenation (VV-ECMO) implantation for severe acute respiratory distress syndrome (ARDS) leads to carbon dioxide partial pressure (PaCO₂) variations associated with intracranial bleeding. 

Researchers conducted a retrospective study to evaluate a progressive dual titration protocol for sweep gas flow and minute ventilation post-VV-ECMO to mitigate significant PaCO₂ variations.

They implemented a dual titration protocol for sweep gas flow & minute ventilation after VV-ECMO implantation in September 2020. This before-after study covered VV-ECMO patients from March 2020 to May 2021, divided into 2 periods, March to August 2020 (control group) & September 2020 to May 2021 (protocol group). The main goal was to measure the absolute change in PaCO₂ within 12 hours of VV-ECMO.Secondary endpoints included initial variations in PaCO₂ (>25 mmHg), intracranial bleeding, and mortality in both groups.

The results showed that 51 patients required VV-ECMO, with 24 in the control group and 27 in the protocol group. The protocol demonstrated feasibility. In the protocol group, the 12-hour mean absolute change in PaCO₂ was significantly lower than in the control group (7 mmHg [6–12] vs. 12 mmHg [6–24], P=0.007). After ECMO implantation, the protocol group experienced fewer large initial variations in PaCO₂ (7% vs. 29%, P=0.04) and less intracranial bleeding (4% vs. 25%, P=0.04). Mortality rates were similar in both groups (35% vs. 46%, P=0.42).

They concluded that dual titration of minute ventilation reduces PaCO₂ variation and intracranial bleeding compared to usual care.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-023-01138-5