{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:21:18Z","timestamp":1785403278711,"version":"3.56.0"},"reference-count":41,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2020,1,28]],"date-time":"2020-01-28T00:00:00Z","timestamp":1580169600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:sub>\n                        IO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      on days 1\u20133 was higher in nonsurvivors than in survivors (0.5 vs 0.4,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .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\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05). In multivariate analysis, ventilator F\n                      <jats:sub>\n                        IO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      was significantly associated with mortality (odds ratio 1.38 for each 0.1 increase in F\n                      <jats:sub>\n                        IO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      , 95% CI 1.09-1.75). Mortality was higher in subjects on high ventilator F\n                      <jats:sub>\n                        IO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      (\u2265 0.5) compared to low ventilator F\n                      <jats:sub>\n                        IO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      (&gt; 0.5) (46% vs 22%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>\n                      Ventilator mode and some settings vary in practice. The only ventilator setting associated with mortality was F\n                      <jats:sub>\n                        IO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      , even after adjustment for disease severity. Ventilator F\n                      <jats:sub>\n                        IO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      is a modifiable setting that may contribute to mortality in children on VV-ECMO.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.07214","type":"journal-article","created":{"date-parts":[[2020,1,28]],"date-time":"2020-01-28T17:33:56Z","timestamp":1580232836000},"page":"271-280","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":29,"title":["Mechanical Ventilation in Children on Venovenous ECMO"],"prefix":"10.1177","volume":"65","author":[{"given":"Matthew L","family":"Friedman","sequence":"first","affiliation":[{"name":"Division of Pediatric Critical Care, Riley Hospital for Children, Indiana University, Indianapolis, Indiana."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan P","family":"Barbaro","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Michigan, Ann Arbor, Michigan."},{"name":"Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melania M","family":"Bembea","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian C","family":"Bridges","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranjit S","family":"Chima","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio."},{"name":"Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd J","family":"Kilbaugh","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poornima","family":"Pandiyan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, Kansas."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee M","family":"Potera","sequence":"additional","affiliation":[{"name":"Department of Pediatrics UT Southwestern Medical Center, Dallas, Texas."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth 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