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Extracorporeal support can facilitate ultra\u2010lung\u2010protective ventilation, meaning even lower volumes and pressures than standard lung\u2010protective ventilation, by directly removing carbon dioxide in patients needing injurious ventilator settings to maintain sufficient gas exchange. Injurious ventilation results in ventilator\u2010induced lung injury, which is one of the main determinants of mortality in acute respiratory distress syndrome. Marked reductions in the intensity of ventilation to the lowest tolerable levels under extracorporeal support may be achieved and could thereby potentially mitigate ventilator\u2010induced lung injury and theoretically patient self\u2010inflicted lung injury in spontaneously breathing patients with high respiratory drive. However, the benefits of this strategy may be counterbalanced by the use of continuous deep sedation and even neuromuscular blocking drugs, which may impair physical rehabilitation and impact long\u2010term outcomes. There are currently a lack of large\u2010scale prospective data to inform optimal invasive ventilation practices and how to best apply a holistic approach to patients receiving veno\u2010venous extracorporeal membrane oxygenation, while minimising ventilator\u2010induced and patient self\u2010inflicted lung injury. We aimed to review the literature relating to invasive ventilation strategies in patients with acute respiratory distress syndrome receiving extracorporeal support and discuss personalised ventilation approaches and the potential role of adjunctive therapies in facilitating lung protection.<\/jats:p>","DOI":"10.1111\/anae.15806","type":"journal-article","created":{"date-parts":[[2022,7,21]],"date-time":"2022-07-21T23:48:43Z","timestamp":1658447323000},"page":"1137-1151","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Invasive mechanical ventilation in patients with acute respiratory distress syndrome receiving extracorporeal support: a narrative review of strategies to mitigate lung injury"],"prefix":"10.1111","volume":"77","author":[{"given":"V.","family":"Zochios","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Critical Care Medicine and ECMO Glenfield Hospital, University Hospitals of Leicester National Health Service Trust  Leicester UK"},{"name":"Department of Cardiovascular Sciences University of Leicester  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Brodie","sequence":"additional","affiliation":[{"name":"Columbia University College of Physicians and Surgeons  New York NY USA"},{"name":"Centre for Acute Respiratory Failure New York\u2010Presbyterian Hospital  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Shekar","sequence":"additional","affiliation":[{"name":"Adult Intensive Care Services and Critical Care Research Group The Prince Charles Hospital  Brisbane QLD Australia"},{"name":"Institute of Health and Biomedical Innovation Queensland University of Technology  Brisbane QLD Australia"},{"name":"Faculty of Medicine University of Queensland, Brisbane and Bond University  Goldcoast QLD Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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