ECLS for Patient Ventilator Synchrony?

Extracorporeal Cardiopulmonary Life Support. Image from MAQUET 

Introduction

Promoting patient  safety and comfort are two main goals when utilizing mechanical ventilation. In patients with severe lung failure maintaining both lung protective goals and patient comfort is a difficult task. One can provide safety by minimizing the set tidal volume to 4-6 ml/kg/IDBW however this leads to flow asynchronies in the patient who has a high inspiratory drive. One can utilize pressure control ventilation to prevent these flow asynchronies conversely this most likely results in tidal volumes greater than lung protective goals. In these patients it is very difficult to balance these two goals of mechanical ventilation and patient comfort is usually sacrificed, or is  accomplished with high levels of sedation and sometimes neuromuscluar blocking agents. 

Increasing sedation and administering neuromuscular blocking agents increases the risk for ventilator induced diaphragmatic dysfunction (VIDD), increased length of stay, and mortality. So it would be ideal to allow for both lung protection and patient comfort (ventilator synchrony) with minimal sedation use.

In the below summarized abstract [1] researchers couple Extracorporeal Cardiopulmonary Life Support (ECLS) with Neurally Adjusted Ventilatory (NAVA) Assist to balance lung protection and patient comfort with little sedation use. 

The Importance of Identifying Patient Ventilator Asynchrony

There are many factors that increase the risks for prolonged mechanical ventilation (PMV). So It is imperative that the practitioner is able to identify factors that they can proactively emend.

One factor associated with PMV is inappropriate ventilator settings. The below abstract reinforces how ventilator asynchrony increases the likelihood of  PMV.