How is ventilation managed in patients on VV ECMO?

In patients on venovenous (VV) ECMO, ventilation management is crucial for supporting lung recovery while minimizing further injury to the lungs. Utilizing low tidal volume ventilation strategies is often preferred as it reduces the risk of ventilator-induced lung injury (VILI). Lower tidal volumes decrease the mechanical stress and strain on the alveolar-capillary membrane, facilitating better lung healing. In some cases, complete sedation may be used to ease patient comfort and reduce spontaneous breathing effort, allowing the lungs to rest and recover without the additional burden of ventilatory work.

This approach aligns with current practices aimed at lung protective ventilation, which emphasizes minimizing the risk of additional harm to already compromised lung tissue. These strategies are vital, especially in patients suffering from conditions like acute respiratory distress syndrome (ARDS), for which VV ECMO is often indicated.

Choosing complete sedation or low tidal volume ensures that while the patient is supported by ECMO for gas exchange, the injured lungs are given the opportunity to heal with as little mechanical disruption as possible.